Betamethasone is a corticosteroid given during pregnancy when preterm birth is expected within the coming days. It crosses the placenta and speeds up development of the baby’s lungs and other organs, lowering the risk of respiratory distress syndrome, bleeding in the brain, serious intestinal complications, and newborn death.
Understanding Antenatal Corticosteroids Before Preterm Birth
When a baby is likely to be born early, one of the most important things the care team can do is give the mother a course of antenatal corticosteroids, most commonly betamethasone. These medications speed up development of the baby’s lungs and other organs and lower the risk of some of the most serious complications of prematurity, including breathing problems and bleeding in the brain. If your baby was born early and steroids were delayed or not given, the timing, gestational age, and clinical circumstances can help clarify what happened and whether the care met the accepted standard.
What are antenatal corticosteroids?
Antenatal corticosteroids are medications given to a pregnant patient when preterm delivery is expected within the coming days. Betamethasone is the most commonly used and is typically given as two injections 24 hours apart. The medication crosses the placenta and accelerates maturation of the baby’s lungs, brain, and other organs before birth.
A course of antenatal corticosteroids has been shown to reduce the risk of respiratory distress syndrome, intraventricular hemorrhage (bleeding in the brain), necrotizing enterocolitis (a serious intestinal condition), and newborn death. They do not eliminate these risks, and a premature baby who receives them may still have complications. Their purpose is to lower the risk and severity of the problems that come with being born too early.
Under current obstetric guidance, a course of steroids is generally recommended for patients at risk of delivering between about 24 and 34 weeks of pregnancy. Steroids may also be considered in the periviable period (around 22 to 23 weeks) and in certain late preterm pregnancies (34 to 36 weeks) when specific criteria are met. Whether treatment is recommended in an individual case depends on gestational age, how likely delivery is within the next week, whether a prior course has already been given, and the specific maternal and fetal circumstances.
What can lead to a missed or delayed course?
Sometimes a baby is born so quickly that there is not enough time to complete, or even begin, a course of steroids. A missed or incomplete course is not automatically evidence that care was improper.
When there was time to evaluate and treat a patient at meaningful risk of preterm delivery, factors that can contribute to a missed or delayed opportunity include:
- Signs of preterm labor or cervical change not being recognized or evaluated promptly
- Preterm prelabor rupture of membranes or another risk of early delivery not being addressed in a timely manner
- A planned, medically indicated preterm delivery scheduled without timely consideration of antenatal corticosteroids
- Delays during admission, transfer, consultation, or medication ordering
- Communication or documentation errors about whether a prior steroid course was given
- Rapid progression to delivery that leaves limited time for treatment, even when care is appropriate
When failure to timely administer antenatal corticosteroids may be medical malpractice
Not every missed or incomplete course of steroids is medical malpractice. Some patients are not appropriate candidates, preterm birth can occur with little warning, and an urgent maternal or fetal condition may require delivery without waiting to complete treatment.
Depending on the gestational age, clinical circumstances, and time available before birth, the following scenarios may point to negligence:
- Failing to recognize that a patient was at meaningful risk of preterm delivery within the treatment window
- Unreasonably delaying evaluation or treatment after signs of preterm labor, cervical change, or ruptured membranes were identified
- Failing to consider antenatal corticosteroids when a medically indicated preterm delivery was anticipated and time allowed for treatment
- A medication, ordering, communication, or transfer error that resulted in a missed dose or delayed first dose
- Incorrectly documenting that steroids had already been given, causing the care team to omit appropriate treatment
- Failing to follow an appropriate hospital or obstetric protocol for a patient who met the clinical criteria for treatment
Wais, Vogelstein, Forman, Koch & Norman, LLC works with medical experts to review the prenatal, labor, delivery, and newborn records and evaluate whether antenatal corticosteroids were indicated, whether there was a meaningful opportunity to give them, and whether a delay or omission may be related to a baby’s injuries.
Treatment and long-term outlook after preterm birth
If a baby is born prematurely without a full course of steroids, newborn care is based on gestational age, condition at birth, and the complications that develop. Many premature newborns need care in a neonatal intensive care unit, including breathing support, temperature support, feeding assistance, and close monitoring for bleeding in the brain and other complications.
Even a partial course of steroids may provide benefit when birth occurs before both doses can be given, which is why the timing of the first dose can matter. At the same time, an urgent delivery should never be delayed solely to complete steroid treatment.
The long-term outlook for premature children varies widely. A missed or delayed steroid course does not by itself establish that a later medical or developmental condition was caused by the omission. When a possible malpractice claim is reviewed, medical experts examine the newborn’s respiratory course, brain imaging, neurological findings, NICU records, and other evidence to determine whether the timing of treatment could have affected a specific injury, such as respiratory distress syndrome or a brain bleed.
Frequently Asked Questions
Common questions about antenatal corticosteroids and preterm birth.
Questions about a missed or delayed steroid course can be difficult to untangle, but reviewing the timing and medical records can help families understand what happened.
What is betamethasone and why is it given before preterm birth?
Is failure to give betamethasone always medical malpractice?
No. Whether betamethasone is appropriate depends on gestational age, how likely and how soon delivery is expected, prior steroid treatment, and the maternal and fetal circumstances. Some deliveries also become urgent so quickly that treatment cannot be started or completed safely. A malpractice review asks whether the care team had a reasonable opportunity to give the medication and failed to do so.
Can a baby benefit if only one dose of betamethasone is given?
Yes. A full course is preferred when time allows, but research in very preterm infants suggests that even a single dose given shortly before birth may provide benefit. This is one reason the timing of the first dose is often examined closely.
How long do families have to file a claim involving delayed antenatal corticosteroids?
The deadline, or the statute of limitations, depends on the state where the care occurred and on who is bringing the claim. A claim for harm to the mother often follows a different timeline than a claim brought on behalf of a child, and many states allow more time for a child’s claim. The deadline may also depend on when the injury was discovered, the provider involved, and whether special notice requirements apply. Because these rules vary and can be shorter than families expect, speaking with an attorney promptly can help you understand the time limits that apply to your situation.
