Antenatal administration of betamethasone to prevent respiratory distress syndrome in preterm infants: report of a UK multicentre trial

Abstract

SummaryIn a prospective, randomized, double‐blind, multicentre trial the effect of antenatal treatment with betamethasone phosphate was compared with placebo in the prevention of the respiratory distress syndrome (RDS) in preterm infants. The dose of betamethasone was 4 mg every 8 h for six doses, unless delivery occurred. The 251 women who were enrolled gave birth to 262 liveborn infants, 130 in the betamethasone and 132 in the placebo group; the two groups were evenly matched in most respects. The diagnosis of RDS in the newborn was confirmed by two independent assessors. Seven of the 130 infants in the betamethasone group and 16 of the 132 in the placebo group developed RDS. In infants whose mothers had received at least three injections, RDS was also less frequent in the steroid group than in the placebo group (3/104 and 10/104 respectively; P<0·05). There was a significant reduction of RDS in those born between 24 h and 6 days after entry into the trial (0/30 and 8/45 respectively; P<0·05). The largest difference in frequency of RDS occurred in the subgroup of infants born before 34 weeks gestation, within 8 days of trial entry, and whose mothers had received at least three injections (0/27 steroid group and 7/32 placebo group; P=0·03), and there were also significantly fewer neonatal deaths (2/27 and 13/32, respectively; P<0·01) in this subgroup. Betamethasone did not provoke earlier delivery. Premature rupture of the membranes and maternal hypertension did not seem to contraindicate the use of steroids: there was no increase in maternal or neonatal sepsis nor in stillbirth in hypertensive pregnancies in the steroid group. Neonatal jaundice was significantly less frequent in the steroid (55/129) than in the placebo group (81/127; P<0·01) but not in the subgroups born before 34 completed weeks gestation.

Neonatal management and outcome in alloimmune hemolytic disease

“…Antenatal treatment with corticosteroids has been shown to accelerate lung maturation in preterm infants and reduce the risks of respiratory disorders, especially in those born before 34-week gestation [57]. Although antenatal betamethasone given after 34-week gestation does not appear to decrease the risk of respiratory disorders, recent studies reveal that betamethasone reduces the risk of neonatal jaundice requiring phototherapy, possibly because of acceleration of liver maturation [58].…”

Antenatal treatment with corticosteroids for preterm neonates: impact on the incidence of respiratory distress syndrome and intra-hospital mortality

“…After this classic study, many others were made. [5][6][7][8][9][10][11][12][13][14][15][16] Nevertheless, these studies were not enough to stimulate the routine use of antenatal corticosteroids in obstetric practice. This situation persisted until 1990, when Crowley et al 17 brought together 12 controlled studies of good methodological quality in a meta-analysis.…”

New insights into spontaneous intestinal perforation using a national data set (3): antenatal steroids have no adverse association with spontaneous intestinal perforation

“…1 Their overall positive effect on neonatal mortality and morbidity has been repeatedly documented in a variety of gestational age infants including the extremely low birth weight (ELBW) population. [2][3][4] Spontaneous intestinal perforation (SIP) is a disease of the developing intestinal tract that appears to involve two populations of infants: the ELBW infant and an older, heavier population of infants. 5 In ELBW infants, the histopathology has been associated with hypertrophy of the intestinal mucosa and a concomitant thinning of the submucosa.…”