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

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BACKGROUND AND PURPOSE:

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

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

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

Learn More – Primary Sources:

Antenatal Corticosteroid Therapy Before 24 Weeks of Gestation: A Systematic Review and Meta-analysis

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Related ObG Topics:

Antepartum Corticosteroids – When to Administer?
Is There Value to the Use of Corticosteroids in Women with Short Cervix Who Are Asymptomatic?

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