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Clinical Reviews
Medwave 2015 Oct;15(9):e6280 doi: 10.5867/medwave.2015.09.6280
Do antenatal corticosteroids in term elective cesarean sections reduce neonatal respiratory morbidity?
Felipe Petour Gazitúa, Javiera Pérez Velásquez
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Key Words: caesarean section, elective surgical procedures, term birth, neonatal respiratory distress syndrome, corticosteroids, betamethasone

Abstract

INTRODUCTION
Neonatal respiratory distress syndrome is closely related to gestational age and mode of birth. Lowest gestational ages and caesarean section are associated with higher risk of developing respiratory distress syndrome. The efficacy of antenatal corticosteroids is well established in the induction of lung maturation in premature births. Its use could be a beneficial intervention in term fetuses that will be born by elective caesarean section.

OBJECTIVE
To find the best evidence available to determine whether the use of antenatal corticosteroids reduces the incidence of respiratory distress syndrome in term babies born by elective caesarean section.

METHODOLOGY
We searched the available medical literature in different databases: PubMed, LILACS, UpToDate, Trip database, Scielo and Cochrane. We considered controlled, randomized therapeutic studies, performed on humans, in which the intervention included corticosteroids as a treatment in elective term cesareans.

RESULTS
We selected two studies. In both, the intervention was two doses of 12 mg of dexamethasone before the caesarean section. The primary objective in both studies was to analyze the incidence of respiratory distress syndrome and the admission of the newborn into intensive care units. In both studies, there was less incidence of neonatal respiratory distress syndrome, with statistically significant results.

CONCLUSIONS
We concluded that the use of corticosteroids in elective term caesarean section reduces the incidence of neonatal respiratory distress syndrome and the admission into intensive care units. However, we evidenced certain weaknesses that could modify the internal validity of both studies, so it is necessary to develop new studies that could support these findings in order to modify clinical protocols in term elective caesarean sections.


 

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INTRODUCCIÓN
El síndrome de distrés respiratorio neonatal se relaciona con la edad gestacional y vía de parto. Menor edad gestacional y parto vía cesárea se asocian a mayor riesgo. Con lo anterior, surge la necesidad de evaluar estrategias que reduzcan su incidencia. El uso de corticoides antenatales en la inducción de maduración pulmonar en partos prematuros, podría ser beneficioso en fetos de término en que se programe cesárea.

OBJETIVO
Buscar evidencia bibliográfica que determine si el uso de corticoides antenatales disminuyen la incidencia de síndrome de distrés respiratorio en cesáreas electivas de término.

MÉTODOS
Se realizó búsqueda de literatura médica en PubMed, LILACS, UpToDate, Trip, SciELO y Cochrane. Se incluyeron estudios terapéuticos aleatorizados y controlados, en humanos, cuya intervención fuera con corticoides en cesáreas electivas de término.

RESULTADOS
Se seleccionaron dos estudios cuya intervención fueron dos dosis de 12 mg de dexametasona previas a la cesárea. El objetivo primario de ambos estudios fue analizar la incidencia de síndrome de distrés respiratorio y el ingreso a unidad de cuidados intensivos. En ambos hubo menor incidencia de síndrome de distrés respiratorio en el grupo tratado, con resultados estadísticamente significativos.

CONCLUSIÓN
Se concluye que el uso de corticoides en cesáreas electivas de término disminuye la incidencia de distrés respiratorio e ingreso a unidad de cuidados intensivos. Sin embargo, evidenciamos debilidades que afectan la validez interna de ambos estudios, por lo que es necesario el desarrollo de nuevos estudios que avalen los resultados encontrados para poder cambiar las conductas clínicas en este grupo de estudio.

Authors: Felipe Petour Gazitúa[1], Javiera Pérez Velásquez[1]

Affiliation:
[1] Facultad de Medicina, Universidad de los Andes, Santiago, Chile

E-mail: fapetour@miuandes.cl

Author address:
[1] Mons. Álvaro del Portillo 12455
Las Condes
Santiago
Chile

Citation: Petour Gazitúa F, Pérez Velásquez J. Do antenatal corticosteroids in term elective cesarean sections reduce neonatal respiratory morbidity?. Medwave 2015 Oct;15(9):e6280 doi: 10.5867/medwave.2015.09.6280

Submission date: 7/7/2015

Acceptance date: 28/9/2015

Publication date: 7/10/2015

Origin: not requested

Type of review: reviewed by two external peer reviewers, double-blind

PubMed record

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  1. Rubaltelli FF, Bonafe L, Tangucci M, Spagnolo A, Dani C. Epidemiology of neonatal acute respiratory disorders. A multicenter study on incidence and fatality rates of neonatal acute respiratory disorders according to gestational age, maternal age, pregnancy complications and type of delivery. Italian Group of Neonatal Pneumology. Biol Neonate. 1998;74(1):7-15. | PubMed |
  2. Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. BMJ. 2008 Jan 12;336(7635):85-7. Epub 2007 Dec 11. | PubMed |
  3. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care, 5th edn. Washington: AAP/ACOG, Elk Grove Village; 2002:148.
  4. National Collaborating Centre for Women’s and Children’s Health. Caesarean section. London: National Institute for Clinical Excellence, Clinical Guideline; 2004. | Link |
  5. Uddin SF, Simon AE. Rates and success rates of trial of labor after cesarean delivery in the United States, 1990-2009. Matern Child Health J. 2013 Sep;17(7):1309-14. | CrossRef | PubMed |
  6. Mathews TJ1, Menacker F, MacDorman MF; Centers for Disease Control and Prevention, National Center for Health Statistics. Infant mortality statistics from the 2002 period: linked birth/infant death data set. Natl Vital Stat Rep. 2004 Nov 24;53(10):1-29. | PubMed |
  7. Smith GC, Pell JP, Cameron AD, Dobbie R. Risk of perinatal death associated with labor after previous cesarean delivery in uncomplicated term pregnancies. JAMA. 2002 May 22-29;287(20):2684-90. | PubMed |
  8. Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics. 1972 Oct;50(4):515-25. | PubMed |
  9. Jain L, Eaton DC. Physiology of fetal lung fluid clearance and the effect of labor. Semin Perinatol. 2006 Feb;30(1):34-43. Review. | PubMed |
  10. Venkatesh VC, Katzberg HD. Glucocorticoid regulation of epithelial sodium channel genes in human fetal lung. Am J Physiol. 1997 Jul;273(1 Pt 1):L227-33. | PubMed |
  11. Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. JAMA. 1995 Feb 1;273(5):413-8. | PubMed |
  12. 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 Sep 24;331(7518):662. | PubMed |
  13. 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 Aug;28(12):1486-90. | CrossRef | PubMed |
  14. Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004 Dec 16;351(25):2581-9. | PubMed |
  15. 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 Feb;102(2):101-6. | PubMed |
  16. Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD006614. | CrossRef | PubMed |
  17. Stutchfield PR, Whitaker R, Gliddon AE, Hobson L, Kotecha S, Doull IJ. Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS trial). Arch Dis Child Fetal Neonatal Ed. 2013 May;98(3):F195-200. | CrossRef | PubMed |
  18. Aiken CE, Fowden AL, Smith GC1. Antenatal glucocorticoids prior to cesarean delivery at term. JAMA Pediatr. 2014 Jun;168(6):507-8. | CrossRef | PubMed |
Rubaltelli FF, Bonafe L, Tangucci M, Spagnolo A, Dani C. Epidemiology of neonatal acute respiratory disorders. A multicenter study on incidence and fatality rates of neonatal acute respiratory disorders according to gestational age, maternal age, pregnancy complications and type of delivery. Italian Group of Neonatal Pneumology. Biol Neonate. 1998;74(1):7-15. | PubMed |

Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. BMJ. 2008 Jan 12;336(7635):85-7. Epub 2007 Dec 11. | PubMed |

American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care, 5th edn. Washington: AAP/ACOG, Elk Grove Village; 2002:148.

National Collaborating Centre for Women’s and Children’s Health. Caesarean section. London: National Institute for Clinical Excellence, Clinical Guideline; 2004. | Link |

Uddin SF, Simon AE. Rates and success rates of trial of labor after cesarean delivery in the United States, 1990-2009. Matern Child Health J. 2013 Sep;17(7):1309-14. | CrossRef | PubMed |

Mathews TJ1, Menacker F, MacDorman MF; Centers for Disease Control and Prevention, National Center for Health Statistics. Infant mortality statistics from the 2002 period: linked birth/infant death data set. Natl Vital Stat Rep. 2004 Nov 24;53(10):1-29. | PubMed |

Smith GC, Pell JP, Cameron AD, Dobbie R. Risk of perinatal death associated with labor after previous cesarean delivery in uncomplicated term pregnancies. JAMA. 2002 May 22-29;287(20):2684-90. | PubMed |

Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics. 1972 Oct;50(4):515-25. | PubMed |

Jain L, Eaton DC. Physiology of fetal lung fluid clearance and the effect of labor. Semin Perinatol. 2006 Feb;30(1):34-43. Review. | PubMed |

Venkatesh VC, Katzberg HD. Glucocorticoid regulation of epithelial sodium channel genes in human fetal lung. Am J Physiol. 1997 Jul;273(1 Pt 1):L227-33. | PubMed |

Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. JAMA. 1995 Feb 1;273(5):413-8. | PubMed |

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 Sep 24;331(7518):662. | PubMed |

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 Aug;28(12):1486-90. | CrossRef | PubMed |

Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004 Dec 16;351(25):2581-9. | PubMed |

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 Feb;102(2):101-6. | PubMed |

Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD006614. | CrossRef | PubMed |

Stutchfield PR, Whitaker R, Gliddon AE, Hobson L, Kotecha S, Doull IJ. Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS trial). Arch Dis Child Fetal Neonatal Ed. 2013 May;98(3):F195-200. | CrossRef | PubMed |

Aiken CE, Fowden AL, Smith GC1. Antenatal glucocorticoids prior to cesarean delivery at term. JAMA Pediatr. 2014 Jun;168(6):507-8. | CrossRef | PubMed |