REMARKS Q The GDG noted that only betamethasone was tested in this context but concluded that there were no reasons not to extend the recommendation to dexamethasone. Q The GDG considered evidence that a repeat course of antenatal corticosteroids is associated with a reduction in the composite outcomes (comprising one or more of perinatal death, respiratory distress syndrome, intraventricular haemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, periventricular leukomalacia and neonatal sepsis), as well as respiratory morbidity and less oxygen supplementation and surfactant use (which could save costs). While there was a small reduction in mean neonatal birth weight and increased risk of small-for-gestational-age neonates, the GDG considered these effects to be clinically less significant in the context of the overall benefits for the preterm newborn. Q The GDG considered the evidence that newborn benefit of antenatal corticosteroids may be conferred beyond 7 days and may peak around 14 days after the initiation of the first treatment dose, and therefore recommends that the repeat course of antenatal corticosteroids should be administered between 7 and 14 days after first treatment dose. Q Clinical assessment occurring between 7 and 14 days after initiation of first course of antenatal corticosteroids should consider the gestational age of the pregnancy, and ensuring the woman has a high likelihood of preterm birth in the next 7 days. Antenatal corticosteroid administration to women with a pregnancy >34 weeks’ gestation should be avoided. Q This recommendation applies to women who received an incomplete single course of antenatal corticosteroids at least 7 days prior, and on clinical assessment have a high likelihood of giving birth preterm in the next 7 days. Q This recommendation should only be applied to women between 24 and 34 weeks of gestation at time of the repeat course. Q A single course of antenatal corticosteroids in this context refers to a regimen 24 mg in divided doses, as for recommendation 1.9 in this guideline.

Implementation considerations outlined in Table 2.