Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth

 

Abstract

Background

Respiratory distress syndrome (RDS) is a serious complication of preterm birth and the primary cause of early neonatal mortality and disability.

Objectives

To assess the effects on fetal and neonatal morbidity and mortality, on maternal mortality and morbidity, and on the child in later life of administering corticosteroids to the mother before anticipated preterm birth.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 October 2005). We updated this search on 30 April 2010 and added the results to the awaiting assessment section of the review.

Selection criteria

Randomised controlled comparisons of antenatal corticosteroid administration (betamethasone, dexamethasone, or hydrocortisone) with placebo or with no treatment given to women with a singleton or multiple pregnancy, expected to deliver preterm as a result of either spontaneous preterm labour, preterm prelabour rupture of the membranes or elective preterm delivery.

Data collection and analysis

Two review authors assessed trial quality and extracted data independently.

Main results

Twenty-one studies (3885 women and 4269 infants) are included. Treatment with antenatal corticosteroids does not increase risk to the mother of death, chorioamnionitis or puerperal sepsis. Treatment with antenatal corticosteroids is associated with an overall reduction in neonatal death (relative risk (RR) 0.69, 95% confidence interval (CI) 0.58 to 0.81, 18 studies, 3956 infants), RDS (RR 0.66, 95% CI 0.59 to 0.73, 21 studies, 4038 infants), cerebroventricular haemorrhage (RR 0.54, 95% CI 0.43 to 0.69, 13 studies, 2872 infants), necrotising enterocolitis (RR 0.46, 95% CI 0.29 to 0.74, eight studies, 1675 infants), respiratory support, intensive care admissions (RR 0.80, 95% CI 0.65 to 0.99, two studies, 277 infants) and systemic infections in the first 48 hours of life (RR 0.56, 95% CI 0.38 to 0.85, five studies, 1319 infants). Antenatal corticosteroid use is effective in women with premature rupture of membranes and pregnancy related hypertension syndromes.

Authors' conclusions

The evidence from this new review supports the continued use of a single course of antenatal corticosteroids to accelerate fetal lung maturation in women at risk of preterm birth. A single course of antenatal corticosteroids should be considered routine for preterm delivery with few exceptions. Further information is required concerning optimal dose to delivery interval, optimal corticosteroid to use, effects in multiple pregnancies, and to confirm the long-term effects into adulthood.

[Note: The 16 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

 

Plain language summary

Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth

Corticosteroids given to women in early labour help the babies' lungs to mature and so reduce the number of babies who die or suffer breathing problems at birth.

Babies born very early are at risk of breathing difficulties (respiratory distress syndrome) and other complications at birth. Some babies have developmental delay and some do not survive the initial complications. In animal studies, corticosteroids are shown to help the lungs to mature and so it was suggested these drugs may help babies in preterm labour too. This review of 21 trials shows that a single course of corticosteroid, given to the mother in preterm labour and before the baby is born, helps to develop the baby's lungs and reduces complications like respiratory distress syndrome. Furthermore, this treatment results in fewer babies dying and fewer common serious neurological and abdominal problems, e.g. cerebroventricular haemorrhage and necrotising enterocolitis, that affect babies born very early. There does not appear to be any negative effects of the corticosteroid on the mother. Long-term outcomes on both baby and mother are also good.

 

摘要

背景

產前皮質類固醇用於有早產風險之婦女以加速胎兒肺部成熟

呼吸窘迫症候群(Respiratory distress syndrome (RDS))是一種嚴重的早產併發症，是早期新生兒死亡和失能的主因。

目標

評估在預期早產之前，讓母親使用皮質類固醇對於胎兒和新生兒發病率和死亡率、母親死亡率和發病率、及孩童後來之發育的影響。

搜尋策略

我們搜尋Cochrane Pregnancy和Childbirth Group Trials Register (2005年10月30日)。

選擇標準

隨機控制試驗，比較產前給予皮質類固醇(betamethasone, dexamethasone或hydrocortisone)與安慰劑或無治療，研究對象是懷單胞胎或多胞胎的婦女，且可能由於自發性早產、早產時羊膜早期破水或選擇早產等原因而預期會早產。

資料收集與分析

2位回顧作者評估試驗品質與獨立摘錄資料。

主要結論

納入21篇研究(3885名婦女與4269名嬰兒)。產前皮質類固醇治療並未增加母親之死亡風險、絨毛膜羊膜炎、或產後敗血症。使用產前皮質類固醇治療與新生兒下列的降低有關：整體死亡率(RR為0.69, 95% CI為0.5 0.81, 18篇研究、3956名嬰兒)、呼吸窘迫症候群(RR為0.66, 95% CI為0.59 – 0.73, 21篇研究、4038名嬰兒)、腦室出血(RR為0.54, 95% CI為0.4 0.69, 13篇研究、2872名嬰兒)、壞死性腸炎(RR為0.46, 95% CI為0.29 – 0.74, 8篇研究、1675名嬰兒)、呼吸支持、住進加護病房(RR為0.80, 95% CI為0.65 – 0.99,2篇研究、277名嬰兒)、出生48小時內之全身性感染(RR為0.56, 95% CI為0.38 – 0.85, 5篇研究、1319名嬰兒)。早期破水以及有高血壓相關症狀之婦女使用產前皮質類固醇也是有效。

作者結論

此篇回顧之證據支持可以繼續使用單一療程的產前皮質類固醇，使有早產風險之婦女的胎兒肺部加速成熟。除了少數例外之外，單一療程的產前皮質類固醇可以作為早產的例行處置。下列之更多資訊是需要的：(1)與生產間隔有關的適當劑量、(2)使用適當的皮質類固醇、(3)多胞胎孕婦之影響、(4)小孩子後來成年時的長期影響。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

早產婦女給予皮質類固醇有助於胎兒的肺部成熟，進而減少胎兒死亡或遭遇呼吸問題。早產兒出生時會有呼吸困難 (呼吸窘迫症候群)與其他併發症的風險。有些嬰兒會發育延遲、有些因最初的併發症而無法存活。動物研究中，皮質類固醇顯示有助於肺部成熟，所以認為這些藥物有助於早產嬰兒。回顧的這21篇試驗顯示，在早產孕婦生產前給予單一療程的皮質類固醇，有助於嬰兒肺部成熟且減少呼吸窘迫症候群等併發症。再者，如此治療可以減少嬰兒死亡，且嚴重的神經問題(腦室出血)與腹部問題(壞死性腸炎)也較少。母親使用皮質類固醇看來並無副作用。對於嬰兒和母親的長期預後也不錯。