Corticosteroids for preventing respiratory complications in the newborn after caesarean section at term

Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP

Published Online:

June 15, 2011

Babies born at term (at or after 37 weeks) by planned (elective) caesarean section and before onset of labour are more likely to develop respiratory complications than babies born vaginally. The giving of injections called "corticosteroids" to the mother has been shown to reduce the risk of newborn babies having breathing problems in babies born before 34 weeks, but it is not clear if they are useful after this stage. The risk of respiratory complications, mostly respiratory distress syndrome and transient tachypnoea, decreases from 37 weeks to 39 weeks of gestation, at which stage it is low. The aim of this review was to investigate if corticosteroids can reduce the rates of respiratory problems and the need for admission into special care units when given before planned (not emergency) caesarean section at term.

The review identified only one randomised controlled study involving 942 women. Compared with usual care, giving the mother intramuscular betamethasone can halve the chances of a baby needing special care for respiratory problems, and reduce the chances of the baby being admitted to a neonatal intensive care unit. Much larger numbers of women would be needed to confirm differences in the rates of the respiratory problems themselves and any possible harms of giving the corticosteroids, for the mother and the baby.

Abstract (click to read)

Background:

Infants born at term by elective caesarean delivery are more likely to develop respiratory morbidity than infants born vaginally. Prophylactic corticosteroids in singleton preterm pregnancies accelerate lung maturation and reduce the incidence of respiratory complications.

Objectives:

The objective of this review was to assess the effect of prophylactic corticosteroid administration before elective caesarean section at term, as compared to usual management without corticosteroids, in reducing neonatal respiratory morbidity and admission to special care with respiratory complications.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2009).

Selection criteria:

Randomised and quasi-randomised controlled trials comparing prophylactic antenatal corticosteroid administration (betamethasone or dexamethasone) with placebo or with no treatment, given before elective caesarean section at term (at or after 37 weeks of gestation).

Data collection and analysis:

The co-authors assessed the results of the only available trial independently to retrieve data on perinatal outcomes. Results were expressed as risk ratio (RR) or mean differences (MD), together with their 95% confidence intervals (CI).

Main results:

One study comparing prophylactic administration of betamethasone (N = 467) versus usual treatment without steroids (N = 475) in term elective caesarean section was included in the review. Women randomised to treatment group received two intramuscular doses of betamethasone in the 48 hours before delivery, whereas the control group received treatment as usual.

Prophylactic betamethasone appeared to significantly decrease the risk of admission to the neonatal intensive care unit for respiratory morbidity (RR 0.15; 95% CI 0.03 to 0.64). However, no statistically significant reduction was found in the incidence of neonatal respiratory distress syndrome (RR 0.32; 95% CI 0.07 to 1.58), transient tachypnoea of the newborn (RR 0.52; 95% CI 0.25 to 1.11), need for mechanical ventilation (RR 4.07; 95% CI 0.46 to 36.27) and length of stay in neonatal intensive care unit (MD) -2.14 days; 95% CI -5.58 to 1.30).

There were no reported events of neonatal sepsis, perinatal deaths or maternal trauma infection, therefore results on these outcomes are non-estimable. The study did not provide data on other pre-defined outcomes.

Authors' conclusions:

The results from the single trial are promising, but more studies with larger samples are needed to investigate the effect of prophylactic steroids in the incidence of neonatal complications per se. Also more data and longer follow up would be needed for potential harms and complications.

This record should be cited as:

Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006614. DOI: 10.1002/14651858.CD006614.pub2

Assessed as up to date:

July 16, 2009

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Caesarian section > Other interventions

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Corticosteroids for preventing respiratory complications in the newborn after caesarean section at term

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