OBJECTIVE: To systematically review the efficacy and safety of repeated antenatal corticosteroid on neonatal morbidity, growth and later development. DESIGN: MEDLINE, Cochrane database and a bibliography of identified articles were searched for English language studies. Design. Meta-analysis of randomized controlled trials. SAMPLE: Randomized, controlled trials studying the efficacy and safety of repeat antenatal corticosteroid treatment on neonatal morbidity and early childhood development. MAIN OUTCOME MEASURES: Respiratory distress syndrome, intrauterine growth, neurodevelopment. METHODS: Two reviewers independently assessed titles, abstracts and full studies, extracted data and assessed quality. Meta-analyses were performed, calculating risk ratios and weighted differences of means with 95% confidence intervals using a random-effects model. RESULTS: Eight trials were included. Repeated betamethasone treatment decreased the risk of respiratory distress syndrome (relative risk 0.85, 95% confidence interval 0.77-0.93). Trials involving weekly or biweekly repeated betamethasone and those involving a single rescue dose decreased the risk of respiratory distress syndrome. Intrauterine growth was significantly restricted among preterm infants exposed to weekly or biweekly repeated betamethasone. A single rescue course did not affect growth. Four follow-up studies did not reveal any disturbances in neurodevelopment or growth at two years of corrected age. CONCLUSIONS: Repeated corticosteroid treatment decreased the risk of respiratory distress syndrome among preterm infants. Weekly or biweekly repeated betamethasone restricted intrauterine growth, which raises concerns about long-term consequences on neurodevelopment and metabolism. More follow-up studies are needed to confirm the long-term safety of repeated betamethasone.
OBJECTIVE: To systematically review the efficacy and safety of repeated antenatal corticosteroid on neonatal morbidity, growth and later development. DESIGN: MEDLINE, Cochrane database and a bibliography of identified articles were searched for English language studies. Design. Meta-analysis of randomized controlled trials. SAMPLE: Randomized, controlled trials studying the efficacy and safety of repeat antenatal corticosteroid treatment on neonatal morbidity and early childhood development. MAIN OUTCOME MEASURES: Respiratory distress syndrome, intrauterine growth, neurodevelopment. METHODS: Two reviewers independently assessed titles, abstracts and full studies, extracted data and assessed quality. Meta-analyses were performed, calculating risk ratios and weighted differences of means with 95% confidence intervals using a random-effects model. RESULTS: Eight trials were included. Repeated betamethasone treatment decreased the risk of respiratory distress syndrome (relative risk 0.85, 95% confidence interval 0.77-0.93). Trials involving weekly or biweekly repeated betamethasone and those involving a single rescue dose decreased the risk of respiratory distress syndrome. Intrauterine growth was significantly restricted among preterm infants exposed to weekly or biweekly repeated betamethasone. A single rescue course did not affect growth. Four follow-up studies did not reveal any disturbances in neurodevelopment or growth at two years of corrected age. CONCLUSIONS: Repeated corticosteroid treatment decreased the risk of respiratory distress syndrome among preterm infants. Weekly or biweekly repeated betamethasone restricted intrauterine growth, which raises concerns about long-term consequences on neurodevelopment and metabolism. More follow-up studies are needed to confirm the long-term safety of repeated betamethasone.
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: Edward D Levin; Marty Cauley; Joshua E Johnson; Ellen M Cooper; Heather M Stapleton; P Lee Ferguson; Frederic J Seidler; Theodore A Slotkin Journal: Neurotoxicol Teratol Date: 2013-10-28 Impact factor: 3.763
Authors: D A Iacobas; S Iacobas; T Chachua; C Goletiani; G Sidyelyeva; J Velíšková; L Velíšek Journal: J Neuroendocrinol Date: 2013-11 Impact factor: 3.627