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Prophylactic corticosteroids for preterm birth
1Department of Obstetrics and Gynaecology, Trinity College Dublin, Coombe Womens Hospital, Dublin 8, Ireland. patc@indigo.ie
Insights
Antenatal corticosteroids significantly reduce mortality and respiratory distress syndrome in preterm infants. These treatments are safe for both mother and baby, with no identified adverse effects.
Area of Science:
- Obstetrics and Gynecology
- Neonatology
- Pharmacology
Background:
- Respiratory distress syndrome (RDS) is a major cause of mortality and morbidity in premature infants.
- Effective interventions are crucial to improve outcomes for babies born preterm.
Purpose of the Study:
- To evaluate the efficacy of antenatal corticosteroids in accelerating fetal lung maturity before preterm delivery.
- To assess the impact of these treatments on neonatal outcomes.
Main Methods:
- Systematic review of randomized and quasi-randomized controlled trials.
- Inclusion of trials comparing corticosteroids with placebo or no treatment in women at risk of preterm birth.
- Assessment of eligibility and trial quality by a single reviewer.
Main Results:
- Corticosteroids (betamethasone, dexamethasone, hydrocortisone) significantly reduced mortality (OR 0.60) and respiratory distress syndrome (OR 0.53) in preterm infants.
- Benefits were observed across various gestational ages, genders, and races.
- No adverse consequences of prophylactic corticosteroid use were identified.
Conclusions:
- Antenatal corticosteroids are effective in preventing respiratory distress syndrome and reducing neonatal mortality in preterm births.
- Further research is needed to determine the safety and efficacy of repeated corticosteroid doses in women at ongoing risk of preterm birth.
Background:
Respiratory distress syndrome is a serious complication of prematurity causing significant immediate and long-term mortality and morbidity.
Objectives:
The objective of this review was to assess the effects of corticosteroids administered to pregnant women to accelerate fetal lung maturity prior to preterm delivery.
Search Strategy:
The Cochrane Pregnancy and Childbirth Group trials register was searched.
Selection Criteria:
Randomised and quasi-randomised trials of corticosteroid drugs capable of crossing the placenta compared with placebo or no treatment in women expected to deliver preterm as a result of either spontaneous preterm labour, prelabour rupture of the membranes preterm, or elective preterm delivery.
Data Collection And Analysis:
Eligibility and trial quality were assessed by one reviewer.
Main Results:
Eighteen trials including data on over 3700 babies were included. Antenatal administration of 24 milligrams of betamethasone, of 24 milligrams of dexamethasone, or two grams of hydrocortisone to women expected to give birth preterm was associated with a significant reduction in mortality (odds ratio 0.60, 95% confidence interval 0.48 to 0.75), respiratory distress syndrome (odds ratio 0.53, 95% confidence interval 0.44 to 0.63) and intraventricular haemorrhage in preterm infants. These benefits extended to a broad range of gestational ages and were not limited by gender or race. No adverse consequences of prophylactic corticosteroids for preterm birth have been identified.
Reviewer'S Conclusions:
Corticosteroids given prior to preterm birth (as a result of either preterm labour or elective preterm delivery) are effective in preventing respiratory distress syndrome and neonatal mortality. However there is not enough evidence to evaluate the use of repeated doses of corticosteroids in women who remain undelivered, but who are at continued risk of preterm birth. (This abstract has been prepared centrally.)