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Antenatal Steroids in Preterm Labour for Prevention of Neonatal Deaths

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More Intervention Effect Estimate Summaries

Reference
Mwansa-Kambafwile J, Cousens S, Hansen T, Lawn JE.  Antenatal steroids in preterm labour for the prevention of neonatal deaths due to complications of preterm birth. Int J Epidemiol. 2010 Apr; 39 (Suppl 1): i122-i133.

Background

  • 4 million newborns die annually, and the leading cause of death is direct preterm complications, accounting for > 1 million deaths. (1)
  • The most common cause of deaths among preterm babies is respiratory distress syndrome RDS), an acute lung disease related to immaturity of the lungs and, specifically, surfactant deficiency. (2)
  • Antenatal steroid treatment for women who are at risk of preterm delivery has emerged as the most effective intervention for the prevention of RDS, reducing early neonatal mortality and morbidity. (3)
  • In high-income countries, administration of antenatal steroids is standard care for women with anticipated preterm labour.  (4)  However, antenatal steroids are not routine practice in low-income countries, where most of preterm deaths occur.

Intervention Effects

Antenatal Steroids on Neonatal Mortality among Preterm Infants – High Quality of Evidence

  • 31% reduction in neonatal mortality with antenatal steroid use (RR: 0.69, 95% CI 0.58-0.81) – Cochrane meta-analysis of 18 RCTs (14 were from high-income countries)
  • 53% reduction in neonatal mortality with antenatal steroid use (RR: 0.47, 95% CI 0.35-0.64) – New meta-analysis of 4 RCTs in middle-income countries 
    • For the 14 high-income country studies, there was a 21% reduction (RR: 0.79, CI 0.65-0.96) 
  • 45% reduction in neonatal mortality with antenatal steroid use (RR:  55, 95% CI 0.40-0.76) – 2 observational studies from middle-income countries.

Antenatal Steroids on Neonatal Morbidity among Preterm Infants

  • 34% reduction in RDS with antenatal steroid use (RR: 0.66, 95% CI 0.59-0.73)  - Cochrane meta-analysis of 21 RCTs (mostly from high income countries)
  • 37% reduction in RDS with antenatal steroid use (RR: 0.63, 95% CI 0.49-0.81) – New meta-analysis of 4 RCTs (all middle-income countries)

Intervention Recommendation:  STRONG

  • There is high-quality evidence of a substantial mortality effect of antenatal steroids, and this effect is greater in MICs than in high-income settings.

References from Mwansa-Kambafwile Paper Cited Here

  1. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where? Why? Lancet 2005; 365: 891-900.
  2. Avery ME, Mead J. Surface properties in relation to atelectasis and hyaline membrane disease. Am J Dis Child 1959; 97: 517-23.
  3. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2008; 3: CD004454.
  4. National Institutes of Health.  Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Statement 1994; 12: 1-24.



Background

  • 4 million newborns die annually, and the leading cause of death is direct preterm complications, accounting for > 1 million deaths. (1)
  • The most common cause of deaths among preterm babies is respiratory distress syndrome RDS), an acute lung disease related to immaturity of the lungs and, specifically, surfactant deficiency. (2)
  • Antenatal steroid treatment for women who are at risk of preterm delivery has emerged as the most effective intervention for the prevention of RDS, reducing early neonatal mortality and morbidity. (3)
  • In high-income countries, administration of antenatal steroids is standard care for women with anticipated preterm labour.  (4)  However, antenatal steroids are not routine practice in low-income countries, where most of preterm deaths occur.

Intervention Effects

Antenatal Steroids on Neonatal Mortality among Preterm Infants – High Quality of Evidence

  • 31% reduction in neonatal mortality with antenatal steroid use (RR: 0.69, 95% CI 0.58-0.81) – Cochrane meta-analysis of 18 RCTs (14 were from high-income countries)
  • 53% reduction in neonatal mortality with antenatal steroid use (RR: 0.47, 95% CI 0.35-0.64) – New meta-analysis of 4 RCTs in middle-income countries 
    • For the 14 high-income country studies, there was a 21% reduction (RR: 0.79, CI 0.65-0.96) 
  • 45% reduction in neonatal mortality with antenatal steroid use (RR:  55, 95% CI 0.40-0.76) – 2 observational studies from middle-income countries.

Antenatal Steroids on Neonatal Morbidity among Preterm Infants

  • 34% reduction in RDS with antenatal steroid use (RR: 0.66, 95% CI 0.59-0.73)  - Cochrane meta-analysis of 21 RCTs (mostly from high income countries)
  • 37% reduction in RDS with antenatal steroid use (RR: 0.63, 95% CI 0.49-0.81) – New meta-analysis of 4 RCTs (all middle-income countries)

Intervention Recommendation:  STRONG

  • There is high-quality evidence of a substantial mortality effect of antenatal steroids, and this effect is greater in MICs than in high-income settings.

References from Mwansa-Kambafwile Paper Cited Here

  1. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where? Why? Lancet 2005; 365: 891-900.
  2. Avery ME, Mead J. Surface properties in relation to atelectasis and hyaline membrane disease. Am J Dis Child 1959; 97: 517-23.
  3. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2008; 3: CD004454.
  4. National Institutes of Health.  Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Statement 1994; 12: 1-24.

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