Antenatal steroids and neonatal outcome after chorioamnionitis: a meta‐analysis

Abstract

Background There is debate concerning the safety and efficacy of antenatal steroids in preterm labour with suspected intrauterine infection (chorioamnionitis).Objectives We performed a systematic literature review and metaanalysis aimed at evaluating the efficacy and safety of antenatal steroids in clinical and histological chorioamnionitis.Search strategy MEDLINE, EMBASE, BioMed Central and the Cochrane databases were searched using the terms 'chorioamnionitis OR intrauterine infection' and '*steroids OR *corticoids'.Selection criteria Studies that reported selected neonatal outcome measures in preterm infants with clinical or histological chorioamnionitis, according to antenatal steroid exposure, were eligible.Data collection and analysis Study selection, data extraction and data analysis were performed by two independent investigators. The meta-analysis techniques used included: Mantel-Haenszel analysis; an assessment of study heterogeneity using the Q statistic; and Egger's regression test and funnel plots, to assess publication bias.Main results Seven observational studies were included. In histological chorioamnionitis (five studies), antenatal steroids were associated with reduced mortality (OR = 0.45; 95% CI = 0.30-0.68; P = 0.0001), respiratory distress syndrome (OR = 0.53; 95% CI = 0.40-0.71; P < 0.0001), patent ductus arteriosus (OR = 0.56; 95% CI = 0.37-0.85; P = 0.007), intraventricular haemorrhage (IVH; OR = 0.35; 95% CI = 0.18-0.66; P = 0.001) and severe IVH (OR = 0.39; 95% CI = 0.19-0.82; P = 0.01). In clinical chorioamnionitis (four studies), antenatal steroids were associated with reduced severe IVH (OR = 0.29; 95% CI = 0.10-0.89; P = 0.03) and periventricular leucomalacia (OR = 0.35; 95% CI = 0.14-0.85; P = 0.02).Conclusions Antenatal steroids may be safe and reduce adverse neonatal outcome after preterm birth associated with chorioamnionitis. There is a need for randomised clinical trials to address this issue.

Antenatal betamethasone attenuates intrauterine infection-aggravated hyperoxia-induced lung injury in neonatal rats

“…This finding may be in accordance with the results from a recent meta-analysis showing that, in histological or clinical chorioamnionitis, antenatal steroids were not clearly associated with a reduced incidence of BPD (30). However, this might be related to the timing of the experimental interventions in our study, and further study about different timing of betamethasone treatment would be needed to clarify this.…”

The Association of Histological Chorioamnionitis and Antenatal Steroids on Neonatal Outcome in Preterm Infants Born at Less than Thirty-Four Weeks’ Gestation

“…Been et al [21] recently conducted a meta-analysis of observational studies on this matter and our study adds value to previous studies. The use of antenatal steroids improved outcome of infants and we observed no harmful effects; this is in line with Been et al [21] In addition, Lahra et al [1] recently showed that chorioamnionitis was associated with a decreased incidence of RDS but not BPD.…”

Antenatal glucocorticoids counteract LPS changes in TGF-β pathway and caveolin-1 in ovine fetal lung

“…A recent meta-analysis by Been and colleagues also concluded that antenatal steroids improved neonatal outcomes after preterm birth associated with chorioamnionitis (4). Surprisingly, the antagonistic combination of inflammation and anti-inflammatory glucocorticoids caused more lung maturation than either stimulus alone.…”