Dexamethasone vs. betamethasone.(News)

MIAMI BEACH -- Prenatal dexamethasone is superior to betamethasone in its reduction of two major neonatal morbidity and mortality outcomes--intraventricular hemorrhage and periventricular leukomalacia--according to results of a randomized, double-blind study presented at the annual meeting of the Society for Maternal-Fetal Medicine.

Intraventricular hemorrhage (IVH) was higher in preterm infants who received betamethasone than in those who received dexamethasone in an intent-to-treat analysis of 299 women, Dr. Andrew Elimian said. "Dexamethasone seems more effective at reducing the rate of IVH than betamethasone," he said.

"There was a surprising finding for any grade IVH--17% with betamethasone vs. 5% for the dexamethasone group," said Dr. Elimian of the State University of New York at Stony Brook. The difference was statistically significant (relative risk 2.9).

Dr. Elimian and his associates also found periventricular leukomalacia (PVL) rates of 18% with betamethasone vs. 6.7% with dexamethasone. This finding was statistically significant (relative risk 2.7). PVL is a major cause of cerebral palsy.

The investigators enrolled women at risk of preterm delivery at Stony Brook University Hospital between August 2002 and July 2004. They included women with preterm labor and prolonged premature rupture of membranes, but excluded those with clinical chorioamnionitis, major fetal structural and chromosomal abnormalities, or prior or current steroid exposure.

A total of 150 women were randomized to the betamethasone group, and another 149 were randomized to dexamethasone.

Women in the betamethasone group received 12-mg betamethasone at 0 hours and 24 hours and a ...