title: Neurodevelopmental Outcome After a Single Course of Antenatal Steroids in Children Born Preterm: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  To systematically review and integrate data on the neurodevelopmental outcome of children after administration of a single course of antenatal corticosteroids for threatened preterm labor.
  
  
  METHODS
  MEDLINE, Scopus, CENTRAL, and www.clinicaltrials.gov (inception to August 2014) using combinations of the terms "prenatal," "antenatal," "cortico*," "*steroid*," "betamethasone," "dexamethasone," "neurodevelopment*," "*development*," and "follow-up." We perused the references of the retrieved articles.
  
  
  METHODS
  We included randomized and nonrandomized trials reporting on the neurodevelopmental outcomes of children whose mothers were administered a single course of betamethasone or dexamethasone antenatally for threatened preterm birth as opposed to placebo or no treatment.
  
  
  RESULTS
  Summary risk ratio (RR) was calculated for dichotomous data; standardized mean difference was calculated for trials that measured the same outcome but used different methods. Heterogeneity was assessed using the I statistic. Sensitivity and subgroup analyses were planned according to study design, specific steroid, and mean gestational age at birth. A single course of antenatal corticosteroids was associated with reduced risk for cerebral palsy (seven studies; treated: 390 of 5,199, untreated: 146 of 1,379; RR 0.678, 95% confidence interval [CI] 0.564-0.815), psychomotor development index less than 70 (two studies; treated: 783 of 3,049, untreated: 258 of 969; RR 0.829, 95% CI 0.737-0.933), and severe disability (five studies; treated: 1,567 of 4,840, untreated: 475 of 1,211; RR 0.787, 95% CI 0.729-0.850). Steroid treatment increased the rates of intact survival (six studies; treated: 1,082 of 2,013, untreated: 273 of 561; RR 1.186, 95% CI 1.056-1.332). Betamethasone was found to significantly decrease the risk for severe disability and increase the rate of intact survival. Dexamethasone increased the rate of intact survival; however, data for dexametasone and the other planned subgroup analyses were limited (fewer than 1,000 children at most). The major limitations involved inclusion of nonrandomized studies and scarcity of data on finer neurodevelopmental outcomes.
  
  
  CONCLUSIONS
  A single course of antenatal corticosteroids in women at high risk for preterm birth appears to improve most neurodevelopmental outcomes in offspring born before 34 weeks of gestation.
authors.affiliation: Second Department of Obstetrics and Gynecology and the First Department of Neonatology and Intensive Care Unit, Aristotle University of Thessaloniki, Thessaloniki, and the Department of Obstetrics and Gynecology, University of Ioannina, Ioannina, Greece; the Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus; and the Center for Fetal Therapy, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Sotiriadis
authors.forename: Alexandra
authors.initials: A
authors.lastname: Tsiami
authors.forename: Stefania
authors.initials: S
authors.lastname: Papatheodorou
authors.forename: Ahmet A
authors.initials: AA
authors.lastname: Baschat
authors.forename: Kosmas
authors.initials: K
authors.lastname: Sarafidis
authors.forename: George
authors.initials: G
authors.lastname: Makrydimas
mesh_terms: D001623:Betamethasone / Q000008:administration & dosage; D002547:Cerebral Palsy / Q000453:epidemiology* / Q000517:prevention & control; D002986:Clinical Trials as Topic; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000517:prevention & control; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005865:Gestational Age; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D016017:Odds Ratio; D011247:Pregnancy; D047928:Premature Birth / Q000188:drug therapy*; D012720:Severity of Illness Index
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D001623:Betamethasone