To The Editor: Dr Guinn and colleagues1 found that weekly courses of antenatal corticosteroids
were not superior to a single course in reducing neonatal morbidity, although
their study was terminated early due to safety concerns. Over the past 10
years antepartum corticosteroids have been both the hero and the villain:
praised for lower rates of neonatal death and respiratory distress syndrome
(RDS),2 but criticized for detrimental effects
on birth weight and head circumference when repetitive courses are used.3 Presently, there is a paucity of prospective data
to guide the appropriate dosing for patients who remain pregnant 1 week after
their initial treatment. Unfortunately, this gap in knowledge has not been
filled by the study of Guinn et al. By not completing their randomized controlled
trial (RCT) as originally designed, we believe that their conclusions about
efficacy may be erroneous.
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