GTG - No 74 - Antenatal corticosteroids to reduce neonatal morbidity and mortality Flashcards
What are the benefits of corticosteroids in preterm labour and birth? (high certainty)
A course given within 7 days prior to preterm birth reduced perinatal and neonatal death and respiratory distress syndrome.
What are the benefits of corticosteroids in preterm labour and birth?(moderate certainty)
Reduce intraventricular haemorrhage and reduce developmental delay.
What is the risk of respiratory morbidity at term (39+) LSCS
~5%
What are the pros/cons of corticosteroids in planned LSCS between 37-38+6?
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.
steroids - 22+0 -34+6
What is NNT to reduce perinatal mortality
43.5
steroids 22-34+6.
NNT to reduce neonatal death
38.5
steroids 22-34+6.
NNT to reduce neonatal RDS
23.5
steroids 22-34+6. NNT to likely reduce IVH?
71.4
steroids 22-34+6. NNT to likely reduce developmental delay
27
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?
24-48 hours after STARTING treatment
steroids 22-34+6. If the children are then born at term MAY increase psychiatric and behavioural diagnoses. What is the NNH
38.8
Steroids 35-36+6. NNT to LIKELY reduce respiratory support.
33.3
Steroids 35-36+6. NNH to LIKELY increase neonatal hypoglycaemia.
NNH 11.1
Steroids before planned LSCS 37-39 weeks.
MAY decrease admission to NNU with respiratory support from 51 per 1000 to 23 per 1000. NNT 35.7
In late pre-term birth what are the pros and cons of steroids 35-36+6
Steroids have short term respiratory benefits but increase the likelihood of neonatal hypoglycaemia.
Should women with twins & triplets be offered steroids in line with recommendations with singleton pregnancies?
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.
Should women with multiple pregnancies be offered single or multiple routine (untargeted) courses of steroids?
No
Maternal blood glucose levels rise shortly after administration of corticosteroids.. How long can they remain elevated for?
For up to 5 days.
What is the optimum dose and route of administration of antenatal steroids
Dexamathasone 12mg IM 24 hours apart.
Are there any pros or cons or dexamethasone vs betamethasone?
Cochrane review found dexamethasone reduced the risk of IVH compared to betamethasone.
Dexamethasone is cheaper and does not need to be refrigerated.
What should women be advised regarding long term effects of morbidity or benefits with repeat doses of corticosteroids?
That no reduction in serious morbidity or long-term benefits have been seen with repeat corticosteroids but babies who receive repeat doses are smaller.
Can repeat courses of AN steroids be recommended?
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.
What does the 2022 GTG state about the maximum number of courses of steroids in pregnancy?
The maximim number of corticosteroid courses given in any one pregnancy should not exceed three or a total dose of 24-48mg. Authors opinion.
What is the world health organisation guidance on repeat courses of AN steroids?
WHO recommended a single rescue course if women remain at high risk of PTB and more than 7 days have elapsed since previous treatment.
