Antenatal steroid (ANS) therapy in women at the risk of premature delivery has been shown to reduce mortality and morbidity of VLBW neonates. It is unknown how many weekly ANS courses should be administered to sustain their benefit in undelivered VLBW fetuses without developing fetal adrenal suppression or any other side, effects. We have reviewed the neonatal course of 142 VLBW infants born between July 1995 and November 1996.Table

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Five of ten infants receiving ≥ 4 courses of ANS showed cortisol levels of <5.0mcq/dl during the first 24 hours of life. Except for one infant, all had cortisol > 12 after ACTH stimulation. However, none showed clinical signs of adrenal suppression. More information is required to define the risk-benefit ratio of multiple ANS courses. This data suggestions that ≥2 ANS courses may be superior to ≤1 course. More information is required to know whether repeated courses beyond 2 are necessary to sustain this benefit and/or are detrimental to adrenal function.