Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term.
BACKGROUND
Infants born at term by elective caesarean delivery are more likely to develop respiratory morbidity than infants born vaginally. Prophylactic corticosteroids in singleton preterm pregnancies accelerate lung maturation and reduce the incidence of respiratory complications.


OBJECTIVE
The objective of this review was to assess the effect of prophylactic corticosteroid administration before elective caesarean section at term, as compared to usual management without corticosteroids, in reducing neonatal respiratory morbidity and admission to special care with respiratory complications.


METHODS
We searched the Cochrane Pregnancy and Chilbirth Group's Trials Register (30 June 2009).


METHODS
Randomised and quasi-randomised controlled trials comparing prophylactic antenatal corticosteroid administration (betamethasone or dexamethasone) with placebo or with no treatment, given before elective caesarean section at term (at or after 37 weeks of gestation).


METHODS
The co-authors assessed the results of the only available trial independently to retrieve data on perinatal outcomes. Results were expressed as risk ratio (RR) or mean differences (MD), together with their 95% confidence intervals (CI).


RESULTS
One study comparing prophylactic administration of betamethasone (N = 467) versus usual treatment without steroids (N = 475) in term elective caesarean section was included in the review. Women randomised to treatment group received two intramuscular doses of betamethasone in the 48 hours before delivery, whereas the control group received treatment as usual.Prophylactic betamethasone appeared to significantly decrease the risk of admission to the neonatal intensive care unit for respiratory morbidity (RR 0.15; 95% CI 0.03 to 0.64). However, no statistically significant reduction was found in the incidence of neonatal respiratory distress syndrome (RR 0.32; 95% CI 0.07 to 1.58), transient tachypnoea of the newborn (RR 0.52; 95% CI 0.25 to 1.11), need for mechanical ventilation (RR 4.07; 95% CI 0.46 to 36.27) and length of stay in neonatal intensive care unit (MD) -2.14 days; 95% CI -5.58 to 1.30).There were no reported events of neonatal sepsis, perinatal deaths or maternal trauma infection, therefore results on these outcomes are non-estimable. The study did not provide data on other pre-defined outcomes.


CONCLUSIONS
The results from the single trial are promising, but more studies with larger samples are needed to investigate the effect of prophylactic steroids in the incidence of neonatal complications per se. Also more data and longer follow up would be needed for potential harms and complications.
Sotiriadis
Alexandros
A
Department of Hygiene and Epidemiology, Clinical Trials and Evidence-based Medicine Unit, University of Ioannina School of Medicine, University Campus, Ioannina, Greece, 45110.
Makrydimas
George
G
Papatheodorou
Stefania
S
Ioannidis
John Pa
JP
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001049:Apnea / Q000517:prevention & control; D001623:Betamethasone / Q000627:therapeutic use*; D002585:Cesarean Section / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D010343:Patient Admission / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control
D000305:Adrenal Cortex Hormones; D001623:Betamethasone