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NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes

Larry C. Gilstrap, MD; Robert Christensen, MD; William H. Clewell, MD; Mary E. D'Alton, MD; Ezra C. Davidson, Jr, MD; Marilyn B. Escobedo, MD; Dwenda K. Gjerdingen, MD; Jan Goddard-Finegold, MD; Robert L. Goldenberg, MD; David A. Grimes, MD; Thomas N. Hansen, MD; Ralph E. Kauffman, MD; Emmett B. Keeler, PhD; William Oh, MD; Elizabeth J. Susman, PhD, RN; Marlyn G. Vogel, EdD; Mary Ellen Avery, MD; Philip L. Ballard, MD, PhD; Roberta A. Ballard, MD; Patricia Crowley, MRCOG, FRCPI; Marilyn B. Escobedo, MD; Thomas Garite, MD; Robert L. Goldenberg, MD; Gary D.V. Hankins, MD; Alan H. Jobe, MD, PhD; Ralph E. Kauffman, MD; Janna G. Koppe, MD, PhD; James E. Maher, MD; Irwin R. Merkatz, MD; Seetha Shankaran, MD; Kit N. Simpson, DrPH; John C. Sinclair, MD; Theodore A. Slotkin, PhD; H. William Taeusch, Jr, MD; Linda L. Wright, MD; Duane Alexander, MD; Roberta A. Ballard, MD; Mary Anne Berberich, PhD; Michael Bracken, PhD; Leslie Cooper, PhD; Larry Culpepper, MD, MPH; Jerry M. Elliott; John H. Ferguson, MD; Frederic Frigoletto, MD; Dorothy Berlin Gail, PhD; Larry C. Gilstrap, MD; William H. Hall; Alan H. Jobe, MD, PhD; M. Douglas Jones, Jr, MD; Barbara Medoff-Cooper, PhD; Gerald B. Merenstein, MD; Judith M. Whalen, MPA; Linda L. Wright, MD; John H. Ferguson, MD; Claude Lenfant, MD; Ada Sue Hinshaw, PhD, RN

JAMA. 1995;273(5):413-418.

Abstract
Objective.
—To develop a consensus on the use of antenatal corticosteroids for fetal maturation in preterm infants.

Participants.
—A nonfederal, nonadvocate, 16-member consensus panel including representatives from neonatology, obstetrics, family medicine, behavioral medicine, psychology, biostatistics, and the public; 19 experts in neonatology, obstetrics, and pharmacology presented data to the consensus panel and a conference audience of approximately 500.

Evidence.
—An extensive bibliography of references was produced for the consensus panel and the conference audience using a variety of on-line databases including MEDLINE. The consensus panel met several times prior to the conference to review the literature. It also commissioned an updated meta-analysis, a neonatal registry review, and an economic analysis that were presented at the conference. The experts prepared abstracts for distribution at the conference, presented data, and answered questions from the panel and audience. The panel evaluated the strength of the scientific evidence using the grading system developed by the Canadian Task Force on the Periodic Health Examination and adapted by the US Preventive Services Task Force.

Consensus.
—The consensus panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature.

Consensus Statement.
—The consensus panel composed a draft statement that was read in its entirety at the conference for comment. The panel released a revised statement at the end of the conference and finalized the revisions a few weeks after the conference.

Conclusions.
—Antenatal corticosteroid therapy is indicated for women at risk of premature delivery with few exceptions and will result in a substantial decrease in neonatal morbidity and mortality, as well as substantial savings in health care costs. The use of antenatal corticosteroids for fetal maturation is a rare example of a technology that yields substantial cost savings in addition to improving health.

(JAMA. 1995;273:413-418)

Author Affiliations
Panel, and Conference Chairperson, Professor, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas; Professor and Chief, Neonatology/Pediatrics, University of Florida College of Medicine, Gainesville; Associate Director, Department of Maternal-Fetal Medicine, Phoenix Perinatal Associates, Phoenix, Ariz; Chief of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New England Medical Center-Tufts University, Boston, Mass; Professor and Chairman of Obstetrics and Gynecology, Martin Luther King, Jr/Charles R. Drew University, Los Angeles, Calif; Professor of Pediatrics, Director, Division of Neonatology, University of Texas Health Sciences Center, San Antonio; Associate Professor, Department of Family Practice and Community Health, University of Minnesota, Saint Paul; Associate Professor, Department of Pediatrics and Pathology, Division of Pediatric Neurology, Baylor College of Medicine, Houston, Tex; Director of the Center for Obstetric Research, Professor, Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine; Professor, Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco General Hospital; Professor, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Professor, Department of Pediatrics and Pharmacology, Wayne State University, Children's Hospital of Michigan, Detroit; Senior Mathematician, Department of Social Policy, RAND, Santa Monica, Calif; Professor and Chair, Department of Pediatrics, Brown University School of Medicine, Women and Infants Hospital, Providence, RI; Professor, Biobehavioral Health Program, The Pennsylvania State University, University Park; Psychologist, School District of Hatboro Horsham, Elkins Park, Pa; Planning Committee Chairperson, Director, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md; Professor of Pediatrics, Obstetrics, and Gynecology, Chief, Division of Neonatology, Department of Pediatrics, University of Pennsylvania School of Medicine and Children's Hospital of Philadelphia (Pa); Health Sciences Administrator, Cell and Developmental Biology Branch, Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md; Professor and Vice Chairman, Department of Epidemiology and Public Health, Yale University, New Haven, Conn; Nurse Epidemiologist, Division of Extramural Programs, National Institute of Nursing Research, National Institutes of Health, Bethesda, Md; Research Director, Department of Family Medicine, Brown University Memorial Hospital of Rhode Island, Pawtucket; Program Analyst, Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md; Director, Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md; Chief of Vincent Memorial Obstetrics Division, Massachusetts General Hospital, Boston; Chief, Cell and Developmental Biology Branch, Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md; Professor, Department of Obstetrics and Gynecology, University of Texas, Southwestern Medical Center, Dallas; Director of Communications, Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md; Professor of Pediatrics-Neonatology, Director, Walter P. Martin Research Center, Harbor-UCLA Medical Center, UCLA School of Medicine, Torrance, Calif; Chairman, Department of Pediatrics, University of Colorado School of Medicine, Pediatrician-in-Chief, The Children's Hospital, Denver; Associate Professor, University of Pennsylvania School of Nursing, Philadelphia; Professor, Department of Pediatrics, University of Colorado School of Medicine/The Children's Hospital, Denver; Chief, Office of Science Policy and Analysis, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md; Special Assistant to the Director, Center for Research for Mothers and Children, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md; Office of Medical Applications of Research; Director; National Heart, Lung, and Blood Institute; Director; National Institute of Nursing Research; Director

Footnotes
NIH Consensus Development Conferences are convened to evaluate available scientific information and to resolve safety and efficacy issues related to a biomedical technology. The resultant NIH Consensus Statements are intended to advance understanding of the technology or issue in question and to be useful to health professionals and the public.

NIH Consensus Statements are prepared by a nonadvocate, nonfederal panel of experts based on (1) presentations by investigators working in areas relevant to the consensus questions during a 2-day public session; (2) questions and statements from conference attendees during open discussion periods that are part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and morning of the third day. This statement is an independent report of the panel and is not a policy statement of the NIH or the federal government.

Preparation and distribution of this statement is the responsibility of the Office of Medical Applications of Research of the National Institutes of Health. Free copies of this statement and bibliographies prepared by the National Library of Medicine are available from the Office of Medical Applications of Research, Federal Bldg, Room 618, National Institutes of Health, 7550 Wisconsin Ave MSC 9120, Bethesda, MD 20892 (William H. Hall), or the NIH Consensus Program Information Service by 24-hour voice mail at (800) NIH-OMAR (644-6627).

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