EDITORIAL COMMENT: This and the preceding article analyzing obstetric practice in Australia concerning steroid administration to prevent the respiratory distress syndrome are complementary. Readers should give both careful attention. There seems sufficient evidence available suggesting that a single steroid dose is adequate, and that a prospective randomized trial should be mounted to address the issue of repeat steroid administration, as recommended by both groups of authors, rather than to persist with the possibly/probably unnecessary usual regimen of repeat steroid administration. Such a trial has been proposed by the Australian Collaborative Trials group, the originators of the ACTOBAT and ACTOMgS04 studies. It should be noted that the respiratory distress syndrome (hyaline membrane disease) remains a major contributor to perinatal morbidity and mortality. The Editorial Board and reviewers of this paper do not recommend alteration to current regimens of steroid administration; all are agreed that a prospective randomized trial is required to decide if repeat steroid administration is indicated.
Summary: We sought to determine if the risk of the respiratory distress syndrome (RDS) is increased when preterm delivery occurs greater than 7 days from the last steroid administration. At our hospital, steroids were repeated weekly only on inpatients. Linking pharmacy and delivery records, we analyzed the risk of RDS with preterm delivery by interval since last steroid administration. Discriminant function analysis revealed that adjusted for gestational age, there was a negative correlation between interval since last steroids administration and risk for RDS (p<0.05, n=254). Using analysis of variance to control more precisely for gestational age (28–32 weeks, n=19) we found no difference in the risk for RDS with longer intervals since the last steroid administration. We then used multiway contingency analysis to consider intervals as zero to 7 versus greater than 7 days and similar results were obtained. Our findings suggest that the process of pulmonary maturation induced by steroid administration is permanent rather than transient. Repetitive steroid administration does not appear to be beneficial. Only a large, prospective randomized trial could definitively address the issue of repeat steroid administration. However, on the basis of our findings and review of available literature, we believe there is insufficient data to recommend weekly repeat steroid administration to women at risk for preterm delivery.