Antenatal steroids reduce need for respiratory support in preemies, Finds study

Administration of antenatal corticosteroids (ANC) for impending preterm delivery beyond 34 weeks of gestation continues to be a controversial issue despite various guidelines for obstetricians and gynaecologists.

Hence, Mangesh Deshmukh and Sanjay Patole from the Department of Neonatalogy, Fiona Stanley Hospital, Perth, Western Australia, Department of Neonatalogy, St. John of God Hospital, Subiaco, Perth, Western Australia, School of Medicine, University of Western Australia, Perth, Western Australia carried out the present study to compare outcomes following exposure to ANC for infants born between 34–36⁺⁶ weeks' gestation.

The authors conducted a systematic review of randomised controlled trials (RCT) that reported neonatal outcomes after ANC exposure between 34–36+6 weeks' gestation using Cochrane methodology. Primary outcomes were set at the need for respiratory support (Mechanical ventilation, CPAP, high flow) or oxygen and hypoglycemia. While, the secondary outcomes included respiratory distress syndrome (RDS), transient tachypnoea of newborn (TTN), need for neonatal resuscitation at birth [only in the delivery room immediately after birth (not in neonatal intensive care unit (NICU)], admission to NICU, mortality and developmental follow up. Level of evidence (LOE) was summarised by GRADE guidelines.

The results highlighted in the study were-

1. Seven RCTs (N = 4144) with low to high risk of bias were included.
2. Only one RCT was from high income countries, Meta-analysis (random-effects model) showed (1) reduced need for respiratory support [5 RCTs (N = 3844); RR = 0.68 (0.47–0.98), p = 0.04; I² = 55%; LOE: Moderate] and (2) higher risk of neonatal hypoglycaemia [4 RCTs (N = 3604); RR = 1.61(1.38–1.87), p<0.00001; I² = 0%; LOE: High] after ANC exposure.
3. Neonates exposed to ANC had reduced need for resuscitation at birth.
4. The incidence of RDS, TTN and surfactant therapy did not differ significantly.
5. None of the included studies reported long-term developmental follow up.

Therefore, the authors concluded that " that ANC exposure reduced need for respiratory support, and increased the risk of hypoglycaemia in late preterm neonates. Large definitive trials with adequate follow up for neurodevelopmental outcomes are required to assess benefits and risks of ANC in this population."