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Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth
Fiona C Brownfoot1, Caroline A Crowther, Philippa Middleton
1Discipline of Obstetrics and Gynaecology, University of Adelaide, Women's and Children's Hospital, 1st floor, Queen Victoria Building, 72 King William Road, Adelaide, South Australia, Australia, 5006. fiona.brownfoot@gmail.com
Insights
Dexamethasone may reduce intraventricular hemorrhage in preterm infants compared to betamethasone, but could increase NICU admissions. More research is needed on optimal antenatal corticosteroid regimens for preterm birth prevention.
Area of Science:
- Obstetrics and Gynecology
- Neonatology
- Pharmacology
Background:
- Antenatal corticosteroids are widely used to prevent respiratory distress syndrome in preterm infants.
- Optimal corticosteroid type, dose, frequency, timing, and route of administration remain unclear.
Purpose of the Study:
- To assess the effects of different corticosteroid regimens for women at risk of preterm birth.
Main Methods:
- Searched the Cochrane Pregnancy and Childbirth Group's Trials Register for randomized and quasi-randomized controlled trials.
- Two authors independently assessed trial quality and extracted data.
Main Results:
- Dexamethasone reduced intraventricular hemorrhage compared to betamethasone (RR 0.44, 95% CI 0.21 to 0.92).
- No significant differences were observed for respiratory distress syndrome, bronchopulmonary dysplasia, or perinatal death.
- One trial indicated higher NICU admissions with dexamethasone and increased neonatal sepsis with oral dexamethasone compared to intramuscular.
Conclusions:
- Dexamethasone may offer benefits like reduced intraventricular hemorrhage but potentially higher NICU admissions.
- Evidence suggests intramuscular dexamethasone may be advantageous over oral administration.
- Further trials are urgently needed for commonly used corticosteroids, dosages, and regimen variations.
Background:
Despite the widespread use of antenatal corticosteroids to prevent respiratory distress syndrome in preterm infants, there is currently no consensus as to the type of corticosteroid to use; nor the dose, frequency or timing of use or the route of administration.
Objectives:
To assess the effects of different corticosteroid regimens for women at risk of preterm birth.
Search Strategy:
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008).
Selection Criteria:
Randomised and quasi-randomised controlled trials of antenatal corticosteroid regimens in women at risk of preterm birth.
Data Collection And Analysis:
Two authors assessed trial quality and extracted the data independently.
Main Results:
Ten trials (1089 women and 1161 infants) were included. Dexamethasone decreased the incidence of intraventricular haemorrhage compared with betamethasone (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.21 to 0.92; four trials, 549 infants). No statistically significant differences were seen for other primary outcomes including respiratory distress syndrome, bronchopulmonary dysplasia, severe intraventricular haemorrhage, periventricular leukomalacia, perinatal death, or mean birthweight. Results for biophysical parameters were inconsistent, but mostly no important differences were seen for these, or any other secondary outcome except for neonatal intensive care unit (NICU) admission. In one trial of 105 infants, significantly more infants in the dexamethasone group were admitted to NICU compared with the betamethasone group (RR 3.83, 95% CI 1.24 to 11.87).Oral dexamethasone compared with intramuscular dexamethasone increased the incidence of neonatal sepsis (RR 8.48, 95% CI 1.11 to 64.93) in one trial of 183 infants. No statistically significant differences were seen for other outcomes reported.In one small trial of 69 infants comparing betamethasone acetate and phosphate with betamethasone phosphate no differences were seen for any of the outcomes reported.
Authors' Conclusions:
Dexamethasone may have some benefits compared with betamethasone such as less intraventricular haemorrhage, although perhaps a higher rate of NICU admission (seen in only one trial). Apart from a suggestion from another small trial that the intramuscular route may have advantages over an oral route for dexamethasone, few other conclusions about optimal antenatal corticosteroid regimens were able to be made. Trials of commonly used corticosteroids are most urgently needed, followed by trials of dosages and other variations in regimens.
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