Antenatal corticosteroids for neonates born before 25 Weeks—A systematic review and meta-analysis

Abstract

BackgroundEfficacy of antenatal corticosteroids before 25 weeks of gestation is unclear.ObjectiveTo assess and compare neonatal outcomes following ANC exposure at 22, 23 and 24 weeks of gestation by conducting systematic review and meta- analysis.MethodsA systematic review of randomised controlled trials (RCT) and non-RCTs reporting on neonatal outcomes after exposure to ANC up to 246 weeks of gestation using the Cochrane systematic review methodology. Databases Pubmed, CINAHL, Embase, Cochrane Central library, and online abstracts of conference proceedings including the Pediatric Academic Society (PAS) were searched in Feb 2017. Primary outcome was in-hospital mortality defined as death before discharge during the first admission. Secondary outcomes included severe intraventricular hemorrhage (IVH> grade III and IV)/or periventricular leukomalacia (PVL), necrotising enterocolitis (NEC >stage II) and chronic lung disease (CLD). Meta-analysis was performed using a random-effects model. The level of evidence (LOE) was summarised using the GRADE guidelines.Main resultsThere were no RCTs; 8 high quality non-RCTs were included in the review. Meta-analysis showed reduction in mortality [N = 10109; OR = 0.47(0.39–0.56), p<0.00001; LOE: Moderate] and severe IVH and PVL [N = 5084; OR = 0.71(0.61–0.82), p<0.00001; LOE: Low] after exposure to ANC in neonates born <25 weeks. There was no significant difference in CLD [N = 4649; OR = 1.19(0.85–1.65) p = 0.31; LOE: Low] and NEC [N = 5403; OR = 0.95 (0.76–1.19) p = 0.65; LOE: Low]. Mortality was comparable in neonates born at 22, 23 or 24 weeks.ConclusionModerate to low quality evidence indicates that exposure to ANC is associated with reduction in mortality and IVH/or PVL in neonates born before 25 weeks.

Antenatal corticosteroids in impending preterm deliveries before 25 weeks’ gestation

“…The methodology including the inclusion and exclusion criteria is similar to our previous review 2. We assessed the composite outcome of death with significant morbidity (eg, severe IVH/PVL, CLD, NEC) in this updated review.…”

“…We have reported a systematic review (eight observational studies, 10 109 neonates) assessing the benefits of ANC at extremely preterm (<25 weeks) gestation 2. ANC exposure was associated with significantly reduced mortality and severe intraventricular haemorrhage (IVH)/periventricular leukomalacia (PVL) in neonates born <25 weeks.…”

Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/025, February 2019) – Part 2 with Recommendations on the Tertiary Prevention of Preterm Birth and the Management of Preterm Premature Rupture of Membranes

“…A recently published meta-analysis found 8 non-randomized studies on this issue [32]. The impact on neonatal mortality and morbidity of a single dose of corticosteroids administered in the period GW 22 + 0 to GW 23 + 6 is shown in ▶ Tables 4 and 5.…”

“…▶ Table 5 Effects of antenatal steroids on the outcome of infants between GW 23 + 0 and GW 23 + 6 [32]. Consensus-based Recommendation 6.E29…”

Survival until Discharge of Very-Low-Birth-Weight Infants in Two Croatian Perinatal Care Regions: A Retrospective Cohort Study of Time and Cause of Death

“…Advances in the field of neonatology, i.e. introduction of surfactant therapy 3 and antenatal corticosteroid administration 4 have led to a significant reduction of mortality, especially in developed countries [5][6][7] . Outcomes improve significantly with advancing gestational age, so Bajwa et al found that between 23 and 26 weeks of gestational age (GA), the overall decrease in mortality was 23% for each additional week of GA, yielding a 3% daily decrease in mortality 8 .…”