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Antenatal corticosteroids in impending preterm deliveries before 25 weeks’ gestation
  1. Mangesh Deshmukh1,2,
  2. Sanjay Patole3
  1. 1Department of Neonatal Paediatrics, Fiona Stanley Hospital, Perth, Western Australia, Australia
  2. 2Department of Neonatal Paediatrics, St John of God Subiaco Hospital, Perth, Western Australia, Australia
  3. 3Department of Neonatal Pediatrics, King Edward Memorial Hospital, Perth, Western Australia, Australia
  1. Correspondence to Dr Mangesh Deshmukh, Department of Neonatal Paediatrics, Fiona Stanley Hospital, Perth, Western Australia 6150, Australia; mangesh.deshmukh{at}health.wa.gov.au

Abstract

Antenatal corticosteroid (ANC) use before 25 weeks’ gestation is controversial. Our previous systematic review (eight observational studies, n=10 109) showed that ANC exposure was associated with significantly reduced mortality and severe intraventricular haemorrhage (IVH)/periventricular leukomalacia (PVL) in neonates born <25 weeks. We update our review by adding data (n=3334) from a recent study. We used Cochrane methodology and summarised the results using GRADE (The Grading of Recommendations Assessment, Development and Evaluation) guidelines. Nine high-quality observational studies were included. Meta-analysis (random effects model) showed reduced mortality (n=13 443; OR=0.48 (95% CI 0.42 to 0.55) P<0.00001; level of evidence (LOE): moderate) and IVH or PVL (n=8418; OR=0.70 (95% CI 0.63 to 0.79), P<0.00001; LOE: moderate) in neonates born <25 weeks exposed to ANC. There was no difference in necrotising enterocolitis (NEC) ≥stage II (n=8737; OR=1.01 (95% CI 0.84 to 1.22), P=0.89; LOE: low); incidence of chronic lung disease (CLD) was higher (n=7983; OR=1.32 (95% CI 1.04 to 1.67), P=0.02; LOE: low) in ANC group. Composite outcomes of death/major morbidities (eg, severe IVH, NEC, CLD) were improved after ANC exposure.

  • antenatal
  • corticosteroids
  • mortality
  • outcomes
  • preterm

https://doi.org/10.1136/archdischild-2017-313840

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    Footnotes

    • Contributors MD: conception, handling meta-analysis software, writing first and final draft of the manuscript. SP: conception, design, updating the first and final draft of the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement We have used published data for this manuscript which is available in public domain. In our previous publication (Deshmukh M, Patole S. Antenatal corticosteroids for neonates born before 25 weeks: a systematic review and meta-analysis. PLoS One 2017;12(5):e0176090. doi: 10.1371) linked with this one, we have used mostly published data but some dataset was obtained directly by contacting the authors. Ethical and legal restrictions prevent us from making the minimal data set publicly available. The contact details of authors who provided additional data are given below. Readers may contact them to request the data which should be available on request to all interested researchers: (1) Rintaro Mori: rintaromori@gmail.com; (2) Nadia Bajwa: Nadia.Bajwa@hcuge.ch; (3) Ruth Guinsburg: ruth.guinsburg@gmail.com