Rescue antenatal corticosteroids and neonatal outcomes in twin gestation

Objective: Although repeated antenatal corticosteroids (ACS) courses are not recommended, a single rescue ACS course has been shown to decrease neonatal morbidity among preterm singletons. However, little is known regarding the effects of rescue ACS course in twin pregnancies. Methods: A retrospective cohort study conducted during 2015–2017 at a tertiary-care center including all twins delivered between 24–34 weeks of gestation who received at least one course of ACS. Results: Overall, 162 (70.4%) twins were exposed to a single ACS course and 68 (29.6%) to an additional rescue ACS course. Rescue ACS course was associated with lower rates of respiratory distress syndrome (7.4% vs. 19.1%, p =.03), surfactant use (7.4% vs 18.5%, p =.04) and bronchopulmonary dysplasia (0 vs 8.6%, p =.01) as compared to a single ACS course. In the rescue ACS group, compared to the single ACS group, the rates of composite respiratory adverse outcome (10.3% vs 22.2%, OR [95% CI]: 0.40 (0.17–0.95), p =.04) and any adverse neonatal outcome (13.2% vs 26.5%, OR [95% CI]: 0.42 (0.19–0.92), p =.04) were significantly lower. Hospital stay was also shorter among neonates born to mothers receiving a rescue ACS course (median 23 vs. 30 days, p =.01). No differences were noted in neonatal birthweight, head circumference and the rate of neonatal hypoglycemia. Conclusion: Rescue ACS course was associated with improved respiratory and neonatal outcomes in twin gestations. Further studies are warranted to confirm our findings and better delineate the optimal regimen of rescue ACS in this setting.