Poster Session 3
Category: Prematurity
Poster Session 3
Claribel Solorio, MD (she/her/hers)
Maternal Fetal Medicine Fellow
University of California, San Francisco
University of California, San Francisco, California, United States
Brandon Ganjineh, MD
Obstetrics/Gynecology resident physician
University of California, San Francisco
University of California, San Francisco, California, United States
Ronald Clyman, MD
Professor of pediatrics and neonatologist
University of California, San Francisco
University of California, San Francisco, California, United States
Katelin Kramer, MD, MS
Neonatologist
University of California, San Francisco
University of California, San Francisco, California, United States
Cinthia Blat, MPH
Data Systems Supervisor
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
San Francisco, California, United States
Melissa G. Rosenstein, MD
Maternal-fetal medicine specialist
University of California, San Francisco
University of California, San Francisco, California, United States
At our institution, we prophylactically administer rescue betamethasone once eligible in patients at risk of delivery < 28 weeks due to data that a rescue course decreases the risk of serious grade 3/ 4 interventricular hemorrhage (sIVH) in infants born < 28 weeks. Since respiratory benefits of an initial betamethasone course wane with time, we examined whether respiratory effects of rescue betamethasone course also waned with time if infants delivered after 28 weeks.
Patients who received a rescue betamethasone course and delivered a singleton between the gestational age of 28 0/7 through 33 6/7 at the University of California San Francisco between January 2015 and December 2024 were studied. All patients received an initial course at < 28 weeks. Patients were retrospectively divided into two groups: ( > 10 dtd) received a rescue course > 10 days to delivery and (< 10 dtd) received a rescue course < 10 days to delivery. Respiratory outcomes between groups were compared.
Of the 74 studied patients, 33 (45%) had rescue betamethasone > 10 dtd and 41 (55%) had rescue betamethasone < 10 dtd. No difference in maternal baseline characteristics were seen. The group > 10 dtd were more likely to have received an initial betamethasone course and their rescue course at an earlier gestational age (24.6 vs. 26.7 weeks; p= < 0.001) and (28.7 vs. 30.0 weeks; p= 0.002), respectively. The group > 10 dtd were more likely to deliver at a more advanced gestational age (32.1 vs. 30.0 weeks; p= 0.0002) and had higher birthweights (1,745 vs.1395 grams; p= 0.022). Logistic regression models adjusted for gestational age, birthweight and fetal sex showed that group > 10 dtd were more likely to have 5-minute APGAR scores < 7 [aOR 8.46 (2.47-36.0), p=0.0015] and were more likely to be intubated within 28 days of life [aOR 11.83 (3.09-60.00), p= 0.00091].
Although prophylactic rescue betamethasone decreases the risk of sIVH in infants delivering before 28 weeks, after 28 weeks a more judicious approach (waiting until delivery is more imminent) may improve neonatal respiratory outcomes.