Corticosteroids
A single course of antenatal corticosteroids is defined as either betamethasone 12 mg intramuscularly every 24 hours for two doses or dexamethasone 6 mg every 12 hours for four doses.
In 1972, the first landmark RCT of antenatal corticosteroids in women at risk of PTB performed was associated with a reduction in neonatal mortality (from 15% to 3.2%) and reduction in RDS (from 25.8% to 9%) (76). Over the following decades further RCTs were performed to replicate these results amid fears that steroid exposure may negatively affect the immune system or alter neurodevelopment. It wasn't until 1990 when Patricia Crowley published the Cochrane review of the 12 RCTs of antenatal corticosteroids showing reductions in neonatal mortality and RDS that it began to be adopted into clinical practice. The most recent Cochrane update still shows significant risk reduction in neonatal death (RR 0.69; CI 0.58-0.81), RDS (RR 0.66; CI 0.59-0.73), cerebroventricular haemorrhage (RR 0.54; CI 0.43-0.69), necrotizing enterocolitis (RR 0.46; CI 0.29-0.74), intensive care admissions, and infections within the first 48 hours of life (77).
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