Antenatale Steroide – nicht immer und nicht immer wieder

Antenatal steroids have greatly contributed to the improved outcome of very premature infants. They are associated with reduced mortality and rates of intraventricular hemorrhage, notably in extremely preterm infants. They are associated with reduced mortality and rates of intraventricular hemorrhage, notably in extremely preterm infants <24 weeks gestational age. These successes have engendered inconsiderate administration of antenatal steroids also to women who eventually delivered a term-born infant. The optimal interval between antenatal steroids and delivery is about 1–2 days. The mortality-lowering effect is nearly complete after 16–18 h, while rates of intraventricular hemorrhage may decline slightly further after a second dose given at 24 h. After 7–10 days, the effects gradually wane, but routine repeat administrations confer little benefit (slightly less pulmonary morbidity) and some potential harm (reduced birth weight). Term-born children exposed to antenatal steroids may have increased rates of behavioral problems, epilepsy, and cerebral palsy, as compared to controls. Antenatal steroids should be used judiciously, i.e. only in pregnancies with impending preterm delivery before 34 weeks.