Does implementing a regime of dexamethasone before planned cesarean section at term reduce admission with respiratory morbidity to neonatal intensive care unit? A randomized controlled trial

Abstract

Dexamethasone administration before planned CS at term, as compared to routine management without antenatal steroids, was not associated with a statistically significant reduction in the incidence of admission to NICU with respiratory morbidity.

Is there a Role for Antenatal Corticosteroids in Term Infants before Elective Cesarean Section?

“…Stutchfield et al 22 reported a lower overall rate of IPPV and endotracheal intubation, but they also did not observe a statistical significant difference between de ACS exposed and not exposed group. Regarding the occurrence of RDS this study also revealed similar rates to those described in the literature, [19][20][21][22] and similar to Nada et al 20 and Nooh et al, 21 we also did not observe a statistically significant difference between the ACS-exposed and not exposed groups. In our study, there was no statistically significant difference between the groups regarding the incidence of TTN, as opposed to what was observed in the randomized cohort studies available in the literature, where the incidence of TTN was lower in the ACS exposed group, with a statistically significant difference.…”

“…Finally, according to the results of the aforementioned randomized cohort studies, prophylactic ACS appeared to decrease the risk of RDS (risk ratio [RR] ¼ 0.48; 95%CI ¼ 0.27-0.87; 3,817 participants), TTN (RR ¼ 0.43; 95%CI: 0.29-0.65; 3,821 participants), and admission to NICU for morbidity due to respiratory reasons (RR ¼ 0.42; 95%CI: 0.22-0.79; 3 studies; 3,441 participants), or any indication (RR ¼ 0.14; 95%CI: 0.03-0.61; 1 study; 452 participants), and the length of stay in the NICU by 2.70 days (mean difference [MD] -2.70; 95% CI: -2.76--2.64; 2 studies; 32 participants). [19][20][21][22][23] The present study found no statistically significant difference between the exposed and not exposed group regarding the likelihood of newborn RDS, TTN, and NICU admission, and even when adjusting for gestational age and arterial hypertension, the likelihood for the occurrence of the aforementioned outcomes was not statistically different between the exposed and not exposed newborns.…”

“…In our study, there was no statistically significant difference between the groups regarding the incidence of TTN, as opposed to what was observed in the randomized cohort studies available in the literature, where the incidence of TTN was lower in the ACS exposed group, with a statistically significant difference. [19][20][21][22] The studies available also reported, contrary to us, higher rates of NICU admission and prolonged hospital stay in the ACS not exposed group, although with conflicting results regarding statistical relevance. [19][20][21][22] None of the randomized cohort studies reported data regarding nutrition through nasogastric tube, jaundice with need for phototherapy, sepsis evaluation, treatment with antibiotics, or hypoglycemia.…”

“…[19][20][21][22] The studies available also reported, contrary to us, higher rates of NICU admission and prolonged hospital stay in the ACS not exposed group, although with conflicting results regarding statistical relevance. [19][20][21][22] None of the randomized cohort studies reported data regarding nutrition through nasogastric tube, jaundice with need for phototherapy, sepsis evaluation, treatment with antibiotics, or hypoglycemia. [19][20][21][22][23] Our findings regarding higher rates of hypoglycemia in the ACS-exposed group may reflect the known biological effects of steroids in glycemic profiles.…”

“…Four trials (3,956 women and 3,893 neonates) comparing prophylactic administration of betamethasone or dexamethasone versus placebo with usual treatment without steroids in term elective CS revealed that prophylactic ACS administration appeared to decrease the risk of respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), admission to the neonatal intensive care unit (NICU), and the length of stay in the NICU. [18][19][20][21][22][23] Nonetheless, a follow-up study to the ASTECS trial found that the use of ACS before elective CS was associated with lower school performance. 24 Despite the promising findings in the aforementioned clinical trials, there is not sufficient evidence yet, regarding effectiveness or safety, to support the use of ACS in term elective CS.…”