Antenatal corticosteroids in impending preterm deliveries before 25 weeks' gestation

摘要

Antenatal corticosteroid (ANC) use before 25 weeks' gestation is controversial. Our previous systematic review (eight observational studies, n = 10 109) showed that ANC exposure was associated with significantly reduced mortality and severe intraventricular haemorrhage (IVH)/periventricular leukomalacia (PVL) in neonates born 25 weeks. We update our review by adding data (n = 3334) from a recent study. We used Cochrane methodology and summarised the results using GRADE (The Grading of Recommendations Assessment, Development and Evaluation) guidelines. Nine high-quality observational studies were included. Meta-analysis (random effects model) showed reduced mortality (n = 13 443; OR = 0.48 (95% CI 0.42 to 0.55) P 0.00001; level of evidence (LOE): moderate) and IVH or PVL (n = 8418; OR = 0.70 (95% CI 0.63 to 0.79), P 0.00001; LOE: moderate) in neonates born 25 weeks exposed to ANC. There was no difference in necrotising enterocolitis (NEC) = stage II (n = 8737; OR = 1.01 (95% CI 0.84 to 1.22), P = 0.89; LOE: low); incidence of chronic lung disease (CLD) was higher (n = 7983; OR = 1.32 (95% CI 1.04 to 1.67), P = 0.02; LOE: low) in ANC group. Composite outcomes of death/major morbidities (eg, severe IVH, NEC, CLD) were improved after ANC exposure.