Preterm Premature Rupture of Membranes and the Rate of Neonatal Sepsis After Two Courses of Antenatal Corticosteroids

OBJECTIVE: To evaluate whether a second antenatal corticosteroid course is associated with an increased risk of neonatal sepsis after preterm premature rupture of membranes (PROM). METHODS: This secondary analysis is a cohort study with data from the Maternal-Fetal Medicine Units study on magnesium for neuroprotection. Women with singleton gestations and preterm PROM were eligible. The primary exposure was one compared with two antenatal corticosteroid courses. The primary outcome, neonatal sepsis, was compared between exposed groups. Patient characteristics were analyzed by chi(2) for categorical variables and Student t test or Wilcoxon rank-sum for continuous variables where appropriate. Predictors of neonatal sepsis were analyzed by multivariable logistic regression. RESULTS: One thousand six hundred forty-one patients were eligible. Neonatal sepsis was similar among neonates born to mothers who received one or two antenatal corticosteroid courses (16.2% compared with 17.2%, P=.756, respectively). Adjusting for confounders, the factors associated with neonatal sepsis were length of time from membrane rupture to delivery (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.02-2.26), respiratory distress syndrome (OR 2.11, 95% CI 1.45-3.07), gestational age at delivery in days (OR 0.98, 95% CI 0.95-0.99) and birth weight per 100 g (OR 0.85, 95% CI 0.77-0.94). CONCLUSION: A second maternal antenatal corticosteroid course was not associated with an increased rate neonatal sepsis.