#Grand Rounds

Do Antenatal Corticosteroids Reduce Morbidity in Premature Neonates Prior to 24 weeks?

BACKGROUND AND PURPOSE:

Park et al. (Obstetrics & Gynecology, 2017) sought to determine the effectiveness of antenatal corticosteroids prior to 24 weeks gestation

Systematic Review and meta-analysis
Published randomized or quasi-randomized controlled trials and observational studies including neonates who received antenatal corticosteroids
Primary outcome
- Neonatal mortality up until discharge from the hospital
Secondary outcomes
- Respiratory distress syndrome (RDS), severe intraventricular hemorrhage (grades III and IV), necrotizing enterocolitis (NEC), chronic lung disease at 36 weeks postmenstrual age, retinopathy of prematurity, and neurologic impairment

17 Studies were included, 3 prospective and 14 retrospective observational studies
Data from 3,626 neonates was pooled for the primary outcome
The mortality to discharge was 58.1% in the intervention group, compared with 71.8% in the control, with a “moderate” quality of evidence
Adjusted odds of mortality to discharge were reduced by 52% in the antenatal corticosteroid group compared to control
- Adjusted odds ratio 0.48 (95% CI 0.38–0.61)
- Subgroup analysis of 23 compared to 22 weeks found no difference in mortality to discharge, although small 22 week sample size
There were no significant differences between the groups with respect to secondary outcomes
- Larger sample sizes may be needed to draw firm conclusions around severe morbidities

This study indicates that antenatal corticosteroids prior to 24 weeks may reduce neonatal mortality

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