A meta-analysis cd004454 included 11 trials with 4 857 women between 27 and 30 weeks and 5 915 infants. There was no significant difference in the proportion of infants with a serious outcome (RR 0.92, 95% CI 0.82 to 1.04; 11 trials, n=5 893 infants). There was a reduction in the use of respiratory support in infants exposed to repeat prenatal corticosteroids compared with infants not exposed (RR 0.91, 95% CI 0.85 to 0.97; 10 trials, n=5 791). The number needed to treat (NNT) to benefit was 21 (95% CI 14 to 41) women/fetus to prevent one infant from needing respiratory support. Birth weight z-scores were lower in the repeat corticosteroid group (mean difference -0.12, 95%CI -0.18 to -0.06; 11 trials, n=5 902). Infants exposed to between 2-5 courses of repeat corticosteroids showed a reduction in both serious outcome and the use of respiratory support compared with infants exposed to only a single repeat course.
A Cochrane review [Abstract] 1 included 27 studies with a total of11 925 infants. Treatment with antenatal corticosteroids is associated with an overall reduction in neonatal death T1, respiratory distress syndrome, cerebroventricular haemorrhage, necrotising enterocolitis, respiratory support, intensive care admissions, and systemic infections in the first 48 hours of life. It did not increase risk to the mother of death (RR 0.98, 95% CI 0.06 to 15.50, n=6244), chorioamnionitis (RR 0.86, 95% CI0.69 to 1.08, n=8374) or endometritis (RR 1.14, 95% CI 0.82 to 1.58, n=6764).
| Outcome | Relative effect(95% CI) | Risk with control - Placebo or no treatment | Risk with intervention - Corticosteroids (95% CI) | №of participants(studies) |
|---|---|---|---|---|
| Perinatal deaths | RR 0.85(0.77 to 0.93) | 15.6% | 13.3%(12 to 14.6)2.3% fewer(3.6 fewer to 1.1 fewer) | 9833(14) |
| Respiratory distress syndrome | RR 0.71(0.65 to 0.78) | 14.8% | 10.5%(9.6 to 11.5)4.3% fewer(5.2 fewer to 3.2 fewer) | 11183(27) |
| Intraventricular haemorrhage | RR 0.58(0.45 to 0.75) | 3.3% | 1.9%(1.5 to 2.5)1.4% fewer(1.8 fewer to 0.8 fewer) | 8475(12) |
| Mean birthweight (grams) | 941 g to 2654 g | mean difference 14.02 lower(33.79 lower to 5.76 higher) | 9551(19) | |
Primary/Secondary Keywords