Repeat doses of prenatal corticosteroids for women at risk of preterm birth for preventing neonatal respiratory disease

Abstract

Background Infants born preterm are at high risk of neonatal lung disease and its sequelae. A single course of prenatal corticosteroids has not been shown to be of benefit in babies who are born more than seven days after treatment. It is not known whether there is benefit in repeating the dose of prenatal corticosteroids to women who remain at risk of preterm birth more than seven days after an initial course. Objectives To assess the effectiveness and safety of a repeat dose(s) of prenatal corticosteroids, given to women who remain at risk of preterm birth seven or more days after an initial course of prenatal corticosteroids. Search methods We searched the Cochrane Pregnancy and Childbirth Group Trials Register (January 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 1), MEDLINE (1965 to January 2006), EMBASE (1988 to January 2006) and Current Contents (1997 to January 2006). Selection criteria Randomised controlled trials of women who have already received a single course of corticosteroids seven or more days previously, and who are still considered to be at risk of preterm birth; outcomes compared for women randomised to receive a repeat dose(s) of prenatal corticosteroids, with women given no further prenatal corticosteroids. Data collection and analysis We assessed trial quality and extracted the data independently. Main results Five hundred and fifty‐one women between 24 and 30 weeks' gestation were recruited into the three included trials. Fewer infants in the repeat dose(s) of corticosteroids group had severe lung disease compared with infants in the placebo group (relative risk (RR) 0.64, 95% confidence interval (CI) 0.44 to 0.93, one trial, 500 infants). No statistically significant differences were seen for any of the other primary outcomes that included other measures of respiratory morbidity, small‐for‐gestational age at birth, perinatal death, periventricular haemorrhage, periventricular leucomalacia and maternal infectious morbidity. Fewer infants in the repeat dose(s) of corticosteroids group received surfactant compared with infants in the placebo group (RR 0.65, 95% CI 0.46 to 0.92, two trials, 537 infants). Authors' conclusions Repeat dose(s) of prenatal corticosteroids may reduce the severity of neonatal lung disease. However, there is insufficient evidence on the benefits and risks to recommend repeat dose(s) of prenatal corticosteroids for women at risk of preterm birth for the prevention of neonatal respiratory disease. Further trials are required.