Green-top Guideline No. 7
Antenatal Corticosteroids to Reduce Neonatal Morbidity and Mortality
Antenatal Corticosteroids to Reduce Neonatal Morbidity and Mortality This is the fourth edition of this guideline, which was previously published in April 1996, December 1999 and February 2004.The previous guideline was entitled Antenatal Corticosteroids to Prevent Respiratory Distress Syndrome.
Purpose and scope
The aim of this guideline is to provide up-to-date information on the appropriate use of antenatal corticosteroid therapy in women whose babies are at risk of complications owing to either preterm birth or elective caesarean section at term. This guideline does not assess the effectiveness of tests in the prediction of preterm delivery (e.g. ultrasound scanning for cervical length, cervical fibronectin measurement) or other interventions that may prevent preterm labour (e.g. tocolysis).
There is evidence to suggest that antenatal corticosteroids are effective not only in reducing respiratory distress syndrome (RDS) but also in reducing other complications of prematurity such as intraventricular haemorrhage (IVH). The title of this guideline has been changed to Antenatal Corticosteroids to Prevent Neonatal Morbidity and Mortality to include all groups of women and all outcomes.
Identification and assessment of evidence
This RCOG guideline was developed in accordance with standard methodology for producing RCOG Greentop Guidelines. The Cochrane Library (including the Cochrane Database of Systematic Reviews), DARE, Embase, TRIP, Medline and PubMed (electronic databases) were searched for relevant randomised controlled trials, systematic reviews and meta-analyses and cohort studies.The search was restricted to articles published between 2002 to July 2008. The databases were searched using the relevant MeSH terms, including all subheadings, and this was combined with a keyword search. Search words included ‘steroids’, ‘premature labour’, ‘premature fetus’ and ‘membrane rupture’, and the search was limited to humans and to the English language.The National Library for Health and the National Guidelines Clearing House were also searched for relevant guidelines and reviews.
What are the benefits of antenatal corticosteroids?
Antenatal steroids are associated with a significant reduction in rates of neonatal death, RDS and intraventricular haemorrhage and are safe for the mother. Antenatal corticosteroids have no known benefits for the mother.
A Cochrane review of 21 studies (3885 women and 4269 infants) showed that treatment of women at risk of preterm birth with a single course of antenatal corticosteroids reduced the risk of neonatal death by 31% (95% CI 19–42%), RDS by 44% (95% CI 31–57%) and intraventricular haemorrhage by 46% (95% CI 31%–67%).1 Antenatal corticosteroid use is also associated with a reduction in necrotising enterocolitis, respiratory support, intensive care admissions and systemic infections in the first 48 hours of life compared with no treatment or treatment with placebo.1
Evidence level 1++
RCOG Green-top Guideline No. 7
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© Royal College of Obstetricians and Gynaecologists
At what gestation should antenatal steroids be used?
Clinicians should offer a single course of antenatal corticosteroids to women between 24+0 and 34+6 weeks of gestation who are at risk of preterm birth. Antenatal corticosteroids can be considered for women between 23+0 and 23+6 weeks of gestation who are at risk of preterm birth. The decision to administer corticosteroids at gestations less than 24+0 weeks should be made at a senior level taking all clinical aspects into consideration.
Evidence level 1++
The data are strongest for gestations between 26+0 and 34+6 weeks.The data for pregnancies between 24+0 and 26+0 weeks of gestation are scarce, with only one trial (49 infants) contributing data to...
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