Corticosteroids for fetuses with congenital diaphragmatic hernia: can we show benefit?
OBJECTIVE
Prenatal corticosteroids have been used in fetuses with congenital diaphragmatic hernia (CDH). We tested the utility of steroids by 2 methods.


METHODS
Mothers carrying fetuses with CDH were randomized to 3 weekly doses of betamethasone or placebo starting at 34 weeks. Patients were followed until death or discharge. In a separate cohort study, the CDH Registry was used to compare infants who received prenatal steroids to those who had not.


RESULTS
Thirty-four patients were enrolled at 7 centers, with 32 completing the trial. There were 15 placebo and 17 steroid patients. There was no difference in survival, length of stay, duration of ventilation, or oxygen use at 30 days. For the cohort study, we looked at infants older than 34 weeks who were born after October 2000 when data on prenatal steroids were collected. There were 1093 patients; 390 were evaluable, with 56 receiving steroids. There was no difference in survival, length of stay, ventilator days, or oxygen use at 30 days.


CONCLUSIONS
Neither the trial nor the CDH Registry suggest that late prenatal corticosteroids benefit fetuses with CDH. More than 1700 mothers and fetuses would need to be enrolled in a trial to show a 10% improvement in survival. It is unlikely that late steroids offer benefit to most fetuses with CDH.
Department of Surgery, The University of Texas Medical School Houston, Houston, TX 77030, USA. kevin.p.lally@uth.tmc.edu
Kevin P
KP
Lally
Pietro
P
Bagolan
Stuart
S
Hosie
Pamela A
PA
Lally
Michael
M
Stewart
C Michael
CM
Cotten
Krisa P
KP
Van Meurs
Gregor
G
Alexander
D001623:Betamethasone / Q000627:therapeutic use*; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use; D006548:Hernia, Diaphragmatic / Q000188:drug therapy*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008297:Male
D005938:Glucocorticoids; D001623:Betamethasone