Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth.
BACKGROUND
Despite the widespread use of antenatal corticosteroids to prevent respiratory distress syndrome in preterm infants, there is currently no consensus as to the type of corticosteroid to use; nor the dose, frequency or timing of use or the route of administration.


OBJECTIVE
To assess the effects of different corticosteroid regimens for women at risk of preterm birth.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008).


METHODS
Randomised and quasi-randomised controlled trials of antenatal corticosteroid regimens in women at risk of preterm birth.


METHODS
Two authors assessed trial quality and extracted the data independently.


RESULTS
Ten trials (1089 women and 1161 infants) were included. Dexamethasone decreased the incidence of intraventricular haemorrhage compared with betamethasone (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.21 to 0.92; four trials, 549 infants). No statistically significant differences were seen for other primary outcomes including respiratory distress syndrome, bronchopulmonary dysplasia, severe intraventricular haemorrhage, periventricular leukomalacia, perinatal death, or mean birthweight. Results for biophysical parameters were inconsistent, but mostly no important differences were seen for these, or any other secondary outcome except for neonatal intensive care unit (NICU) admission. In one trial of 105 infants, significantly more infants in the dexamethasone group were admitted to NICU compared with the betamethasone group (RR 3.83, 95% CI 1.24 to 11.87).Oral dexamethasone compared with intramuscular dexamethasone increased the incidence of neonatal sepsis (RR 8.48, 95% CI 1.11 to 64.93) in one trial of 183 infants. No statistically significant differences were seen for other outcomes reported.In one small trial of 69 infants comparing betamethasone acetate and phosphate with betamethasone phosphate no differences were seen for any of the outcomes reported.


CONCLUSIONS
Dexamethasone may have some benefits compared with betamethasone such as less intraventricular haemorrhage, although perhaps a higher rate of NICU admission (seen in only one trial). Apart from a suggestion from another small trial that the intramuscular route may have advantages over an oral route for dexamethasone, few other conclusions about optimal antenatal corticosteroid regimens were able to be made. Trials of commonly used corticosteroids are most urgently needed, followed by trials of dosages and other variations in regimens.
Discipline of Obstetrics and Gynaecology, University of Adelaide, Women's and Children's Hospital, 1st floor, Queen Victoria Building, 72 King William Road, Adelaide, South Australia, Australia, 5006. fiona.brownfoot@gmail.com
Fiona C
FC
Brownfoot
Caroline A
CA
Crowther
Philippa
P
Middleton
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001507:Beclomethasone / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005325:Fetal Organ Maturity / Q000187:drug effects*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000517:prevention & control; D008168:Lung / Q000187:drug effects / Q000196:embryology*; D011247:Pregnancy; D047928:Premature Birth
D000305:Adrenal Cortex Hormones; D003907:Dexamethasone; D001507:Beclomethasone