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Are Weekly Courses of Antenatal Steroids Beneficial or Dangerous?

Kellie E. Murphy, MD, MSc, FRCSC; Mary Hannah, MDCM, FRCSC; Peter Brocklehurst, MBChB, MRCOG, MSc(Epid)
JAMA. 2002;287(2):187-190. doi:10.1001/jama.287.2.186.
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To the Editor: We were disappointed that the study of Dr Guinn and colleagues1 had to be stopped early before reaching its intended sample size and thus lacks power for finding smaller but clinically important reductions in adverse perinatal outcomes. In this study only 502 women were randomized. We are coordinating a study of similar design in Toronto, Ontario, in which women receive repeated courses of antenatal corticosteroids or placebo every 14 days (projected n = 1900). In the United Kingdom a similar study is under way in which antenatal corticosteroids are given every 7 to 14 days. The primary outcomes of this trial are death within the first year of life and mental impairment at 2 years of age. Four thousand neonates will be enrolled to answer this question. Hopefully such studies will provide the additional necessary power to determine if there is important clinical benefit of weekly corticosteroids and to rule out the possibility of harm.

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