BACKGROUND: One course of antenatal corticosteroids reduces the risk of respiratory distress syndrome and neonatal death. Weekly doses given to women who remain undelivered after a single course may have benefits (less respiratory morbidity) or cause harm (reduced growth in utero). We aimed to find out whether multiple courses of antenatal corticosteroids would reduce neonatal morbidity and mortality without adversely affecting fetal growth. METHODS:1858 women at 25-32 weeks' gestation who remained undelivered 14-21 days after an initial course of antenatal corticosteroids and continued to be at high risk of preterm birth were randomly assigned to multiple courses of antenatal corticosteroids (n=937) or placebo (n=921), every 14 days until week 33 or delivery, whichever came first. The primary outcome was a composite of perinatal or neonatal mortality, severe respiratory distress syndrome, intraventricular haemorrhage (grade III or IV), periventricular leucomalacia, bronchopulmonary dysplasia, or necrotising enterocolitis. Analysis was by intention to treat. All patients and caregivers were unaware of the treatment given. This trial is registered as number ISRCTN2654148. FINDINGS: Infants exposed to multiple courses of antenatal corticosteroids had similar morbidity and mortality to those exposed to placebo (150 [12.9%] vs 143 [12.5%]). Those receiving multiple doses of corticosteroids also weighed less at birth than those exposed to placebo (2216 g vs 2330 g, p=0.0026), were shorter (44.5 cm vs 45.4 cm, p<0.001), and had a smaller head circumference (31.1 cm vs 31.7 cm, p<0.001). INTERPRETATION: Multiple courses of antenatal corticosteroids, every 14 days, do not improve preterm-birth outcomes, and are associated with a decreased weight, length, and head circumference at birth. Therefore, this treatment schedule is not recommended. FUNDING: Canadian Institutes of Health Research.
RCT Entities:
BACKGROUND: One course of antenatal corticosteroids reduces the risk of respiratory distress syndrome and neonatal death. Weekly doses given to women who remain undelivered after a single course may have benefits (less respiratory morbidity) or cause harm (reduced growth in utero). We aimed to find out whether multiple courses of antenatal corticosteroids would reduce neonatal morbidity and mortality without adversely affecting fetal growth. METHODS: 1858 women at 25-32 weeks' gestation who remained undelivered 14-21 days after an initial course of antenatal corticosteroids and continued to be at high risk of preterm birth were randomly assigned to multiple courses of antenatal corticosteroids (n=937) or placebo (n=921), every 14 days until week 33 or delivery, whichever came first. The primary outcome was a composite of perinatal or neonatal mortality, severe respiratory distress syndrome, intraventricular haemorrhage (grade III or IV), periventricular leucomalacia, bronchopulmonary dysplasia, or necrotising enterocolitis. Analysis was by intention to treat. All patients and caregivers were unaware of the treatment given. This trial is registered as number ISRCTN2654148. FINDINGS:Infants exposed to multiple courses of antenatal corticosteroids had similar morbidity and mortality to those exposed to placebo (150 [12.9%] vs 143 [12.5%]). Those receiving multiple doses of corticosteroids also weighed less at birth than those exposed to placebo (2216 g vs 2330 g, p=0.0026), were shorter (44.5 cm vs 45.4 cm, p<0.001), and had a smaller head circumference (31.1 cm vs 31.7 cm, p<0.001). INTERPRETATION: Multiple courses of antenatal corticosteroids, every 14 days, do not improve preterm-birth outcomes, and are associated with a decreased weight, length, and head circumference at birth. Therefore, this treatment schedule is not recommended. FUNDING: Canadian Institutes of Health Research.
Authors: Seung Mi Lee; Roberto Romero; Jeong Woo Park; Sun Min Kim; Chan-Wook Park; Steven J Korzeniewski; Tinnakorn Chaiworapongsa; Bo Hyun Yoon Journal: J Matern Fetal Neonatal Med Date: 2012-04-25
Authors: Chressen Catharina Much; Björn Phillip Schoennagel; Jin Yamamura; Ralph Buchert; Hendrik Kooijman; Anne-Kathrin Schätzle; Gerhard Adam; Ulrike Wedegaertner Journal: Eur Radiol Date: 2013-02-16 Impact factor: 5.315
Authors: Montse Palacio; Elisenda Bonet-Carne; Teresa Cobo; Alvaro Perez-Moreno; Joan Sabrià; Jute Richter; Marian Kacerovsky; Bo Jacobsson; Raúl A García-Posada; Fernando Bugatto; Ramon Santisteve; Àngels Vives; Mauro Parra-Cordero; Edgar Hernandez-Andrade; José Luis Bartha; Pilar Carretero-Lucena; Kai Lit Tan; Rogelio Cruz-Martínez; Minke Burke; Suseela Vavilala; Igor Iruretagoyena; Juan Luis Delgado; Mauro Schenone; Josep Vilanova; Francesc Botet; George S H Yeo; Jon Hyett; Jan Deprest; Roberto Romero; Eduard Gratacos Journal: Am J Obstet Gynecol Date: 2017-03-23 Impact factor: 8.661
Authors: Omar Cabrera; Joseph Dougherty; Sukrit Singh; Brant S Swiney; Nuri B Farber; Kevin K Noguchi Journal: Brain Res Date: 2013-12-19 Impact factor: 3.252