Subscribe to RSS
Antenatal Corticosteroids Decrease the Risk of Composite Neonatal Respiratory Morbidity in Planned Early Term Cesarean DeliveriesFunding None.
Objective While administration of antenatal corticosteroids prior to term elective cesarean deliveries has been shown in international randomized controlled trials to decrease the rates of respiratory distress syndrome and transient tachypnea of the newborn, this is not a standard practice in the United States. We aim to determine if the administration of antenatal corticosteroids for fetal lung maturation within 1 week of scheduled early term cesarean delivery resulted in decreased composite respiratory morbidity.
Study Design Historical cohort study including women who underwent scheduled early term cesarean delivery of a singleton, non-anomalous neonate at Mount Sinai Hospital between May 2015 and August 2019, comparing those who completed a course of antenatal corticosteroids within 1 week of delivery to those who did not. The primary outcome was composite respiratory morbidity defined as respiratory distress syndrome, transient tachypnea of the newborn, and neonatal intensive care unit admission for respiratory morbidity. Maternal and neonatal characteristics were compared between groups using t-tests or Wilcoxon-Rank Sum tests for continuous measures and Chi-square or Fisher's exact tests for categorical measures, as appropriate. The outcomes were assessed using logistic regression.
Results History of preterm birth was significantly higher in those who received antenatal corticosteroids compared with those who did not (24.0 vs. 10.9%, p = 0.01). Neonates who were not exposed to antenatal corticosteroids were more likely to experience the composite respiratory morbidity compared with those who were exposed (RR 4.1, 95% CI 1.2–13.7; p = 0.02). Between 37 and 38 weeks, neonates who did not receive steroids were at increased risk of composite respiratory morbidity (RR 11.7, 95% CI 1.5–89.0, p < 0.01), however, there was no difference for those born between 38 and 39 weeks.
Conclusion Betamethasone course administered prior to planned early term cesarean delivery was associated with a statistically significant reduction in the neonatal composite respiratory morbidity compared with routine management.
Steroids administered prior to scheduled cesarean lead to decreased neonatal respiratory morbidity.
Steroid administration was not associated with increased adverse neonatal outcomes.
Steroid administration was most beneficial between 37 and 38 weeks.
Keywordsbetamethasone - neonatal complications - respiratory distress - respiratory morbidity - term - transient tachypnea of the newborn
The study was presented at the 40th annual pregnancy meeting of the Society for Maternal-Fetal Medicine, Grapevine, TX, February 3 to 8, 2020.
Received: 18 March 2021
Accepted: 05 October 2021
20 October 2021 (online)
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol 1995; 102 (02) 101-106
- 2 NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. Effect of corticosteroids for fetal maturation on perinatal outcomes. JAMA 1995; 273 (05) 413-418
- 3 Gyamfi-Bannerman C, Thom EA, Blackwell SC. et al; NICHD Maternal–Fetal Medicine Units Network. Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med 2016; 374 (14) 1311-1320
- 4 Jain L, Dudell GG. Respiratory transition in infants delivered by cesarean section. Semin Perinatol 2006; 30 (05) 296-304
- 5 Zanardo V, Simbi AK, Franzoi M, Soldà G, Salvadori A, Trevisanuto D. Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery. Acta Paediatr 2004; 93 (05) 643-647
- 6 March of Dimes Prematurity Prevention Resource Center. 2012 . Accessed February 20, 2021 at: http://www.prematurityprevention.org
- 7 Bick D. National Collaborating Centre for Women's and Children's Health, National Institute for Clinical Excellence. Caesarean section. Clinical Guideline. National Collaborating Centre for Women's and Children's Health: commissioned by the National Institute for Clinical Excellence. Worldviews Evid Based Nurs 2004; 1 (03) 198-199
- 8 Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP, McGoldrick E. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev 2018; 8 (08) CD006614
- 9 Stutchfield P, Whitaker R, Russell I. Antenatal Steroids for Term Elective Caesarean Section (ASTECS) Research Team. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial. BMJ 2005; 331 (7518): 662
- 10 Ahmed MR, Sayed Ahmed WA, Mohammed TY. Antenatal steroids at 37 weeks, does it reduce neonatal respiratory morbidity? A randomized trial. J Matern Fetal Neonatal Med 2015; 28 (12) 1486-1490
- 11 Nada AM, Shafeek MM, El Maraghy MA, Nageeb AH, Salah El Din AS, Awad MH. Antenatal corticosteroid administration before elective caesarean section at term to prevent neonatal respiratory morbidity: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2016; 199: 88-91
- 12 Nooh AM, Abdeldayem HM, Arafa E, Shazly SA, Elsayed H, Mokhtar WA. 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. J Matern Fetal Neonatal Med 2018; 31 (05) 614-620
- 13 Bhuta T, Kent-Biggs J, Jeffery HE. Prediction of surfactant dysfunction in term infants by the click test. Pediatr Pulmonol 1997; 23 (04) 287-291
- 14 James DK, Chiswick ML, Harkes A, Williams M, Hallworth J. Non-specificity of surfactant deficiency in neonatal respiratory disorders. Br Med J (Clin Res Ed) 1984; 288 (6431): 1635-1638
- 15 O'Brodovich HM. Immature epithelial Na+ channel expression is one of the pathogenetic mechanisms leading to human neonatal respiratory distress syndrome. Proc Assoc Am Physicians 1996; 108 (05) 345-355