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OBJECTIVE: Early onset preeclampsia (PE) is associated with increased maternal and neonatal morbidity, often warranting prompt delivery following diagnosis. Those who remain pregnant for 7-14 days after course of antenatal corticosteroids (ANCS) while still under 34 weeks gestation may be candidates for rescue ANCS course. Data suggests neonatal respiratory benefit from a single additional course of ANCS in the setting of preterm labor. We aimed to explore whether the same benefit is observed in expectant management of early onset PE. STUDY DESIGN: Retrospective chart review of pregnancies diagnosed with early onset PE, defined as PE with severe features that developed < 34 weeks of gestation, that delivered at a single tertiary care center between 2011-2020. Women were excluded if they had an incomplete course of ANCS (single dose), fetal demise or fetal anomaly. Our primary outcome was a composite of neonatal outcomes, including respiratory distress syndrome (RDS), intubation within 24 hours of life, and any oxygen supplementation. Results were adjusted for gestational age at delivery and infant sex. RESULTS: Of 261 patients identified, 234 patients completed at least one course of ANCS and 27 (11.5%) received at least one dose of rescue ANCS. Maternal age, gestational age at delivery, nulliparity, ethnicity/race, and history of pregestational diabetes, indication for delivery, birthweight and infant sex were similar between groups. (Table 1) The time interval from initial ANCS course to rescue dose was a median of 17 days . There was no difference in the composite of adverse neonatal outcomes, including supplemental oxygen. (Table 2) CONCLUSION: Administration of rescue ANCS in expectantly managed pregnancies complicated by early onset PE did not improve neonatal outcomes. Larger studies are necessary to confirm these findings.