Prenatal steroids may be justified at 23 weeks.(News)

SAN FRANCISCO -- New data suggest that giving prenatal steroids to women at risk of preterm delivery might be beneficial as early as 23 weeks' gestation, said Avroy A. Fanaroff, M.B.

Currently, most physicians give prenatal corticosteroids to enhance fetal maturation in women at risk of preterm delivery between 24 and 35 weeks' gestation, in concordance with a 1994 National Institutes of Health Consensus Development Conference Statement.

A recent study of neonatal outcomes after delivery at 23-28 weeks' gestation at 16 academic medical centers compared survival rates with or without prenatal steroids and with or without cesarian delivery. Among babies delivered at 23 weeks, only 9% who did not get prenatal steroids or cesarian delivery survived, he said at a conference on ob.gyn., perinatal medicine, neonatology, and the law.

With administration of prenatal steroids or delivery by C-section, survival improved to 31% after delivery at 23 weeks. With prenatal steroid administration and use of C-section, approximately 40% of babies delivered at 23 weeks survived, said Dr. Fanaroff, professor and chairman of pediatrics and professor of reproductive biology at Case Western Reserve University, Cleveland.

"Maybe we can extend the consensus a week," he said. "Twenty-three weeks may still be reasonable to give prenatal steroids, particularly if we can extend the time in utero."

Only a fraction of the 3,560 deliveries in the study were at 23 weeks, however, so the results come from a very small number of patients, Dr. Fanaroff said.

The advantage in survival conferred by C-section delivery at 23 weeks disappeared by 24 weeks' gestation, he added at the meeting, sponsored by Boston University and the Center for Human ...