GTG - No 74 - Antenatal corticosteroids to reduce neonatal morbidity and mortality

Question 1

What are the benefits of corticosteroids in preterm labour and birth? (high certainty)

Answer 1

A course given within 7 days prior to preterm birth reduced perinatal and neonatal death and respiratory distress syndrome.

Question 2

What are the benefits of corticosteroids in preterm labour and birth?(moderate certainty)

Answer 2

Reduce intraventricular haemorrhage and reduce developmental delay.

Question 3

What is the risk of respiratory morbidity at term (39+) LSCS

Answer 3

~5%

Question 4

What are the pros/cons of corticosteroids in planned LSCS between 37-38+6?

Answer 4

1) May reduce NNU admission.
2)Uncertainty if there is any reduction in RDS, TTN or NNU admission overall
3) May result in harm - hypoglycaemia and potential developmental delay.

Question 5

steroids - 22+0 -34+6
What is NNT to reduce perinatal mortality

Answer 5

43.5

Question 6

steroids 22-34+6.
NNT to reduce neonatal death

Answer 6

38.5

Question 7

steroids 22-34+6.
NNT to reduce neonatal RDS

Answer 7

23.5

Question 8

steroids 22-34+6. NNT to likely reduce IVH?

Answer 8

71.4

Question 9

steroids 22-34+6. NNT to likely reduce developmental delay

Answer 9

27

Question 10

During what specific time period (within the ideal 7 day window) are steroids most likely to reduce perinatal mortality, neonatal death, RDS, IVH and developmental delay?

Answer 10

24-48 hours after STARTING treatment

Question 11

steroids 22-34+6. If the children are then born at term MAY increase psychiatric and behavioural diagnoses. What is the NNH

Answer 11

38.8

Question 12

Steroids 35-36+6. NNT to LIKELY reduce respiratory support.

Answer 12

33.3

Question 13

Steroids 35-36+6. NNH to LIKELY increase neonatal hypoglycaemia.

Answer 13

NNH 11.1

Question 14

Steroids before planned LSCS 37-39 weeks.

Answer 14

MAY decrease admission to NNU with respiratory support from 51 per 1000 to 23 per 1000. NNT 35.7

Question 15

In late pre-term birth what are the pros and cons of steroids 35-36+6

Answer 15

Steroids have short term respiratory benefits but increase the likelihood of neonatal hypoglycaemia.

Question 16

Should women with twins & triplets be offered steroids in line with recommendations with singleton pregnancies?

Answer 16

There is little direct evidence of benefit but no indication that the effects would be different.
Uncertainties around benefits and risks should be discussed with the woman.

Question 17

Should women with multiple pregnancies be offered single or multiple routine (untargeted) courses of steroids?

Answer 17

No

Question 18

Maternal blood glucose levels rise shortly after administration of corticosteroids.. How long can they remain elevated for?

Answer 18

For up to 5 days.

Question 19

What is the optimum dose and route of administration of antenatal steroids

Answer 19

Dexamathasone 12mg IM 24 hours apart.

Question 20

Are there any pros or cons or dexamethasone vs betamethasone?

Answer 20

Cochrane review found dexamethasone reduced the risk of IVH compared to betamethasone.
Dexamethasone is cheaper and does not need to be refrigerated.

Question 21

What should women be advised regarding long term effects of morbidity or benefits with repeat doses of corticosteroids?

Answer 21

That no reduction in serious morbidity or long-term benefits have been seen with repeat corticosteroids but babies who receive repeat doses are smaller.

Question 22

Can repeat courses of AN steroids be recommended?

Answer 22

There is currently limited evidence to recommend repeat courses of antenatal steroids if a woman remains at imminent risk of PTB 7 days after administration. A repeat course may reduce the need for neonatal respiratory support.

Question 23

What does the 2022 GTG state about the maximum number of courses of steroids in pregnancy?

Answer 23

The maximim number of corticosteroid courses given in any one pregnancy should not exceed three or a total dose of 24-48mg. Authors opinion.

Question 24

What is the world health organisation guidance on repeat courses of AN steroids?

Answer 24

WHO recommended a single rescue course if women remain at high risk of PTB and more than 7 days have elapsed since previous treatment.