Cochrane · systematic review · CD003935
Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes
Walters, A, McKinlay, C, Middleton, P, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
Pregnancy and ChildbirthAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
22
current version
GRADE rated
20
No studies
2
Included studies
NR
No studies 2 · 9.1%Ungraded 0 · 0%Very low 0 · 0%Low 4 · 18.2%Moderate 12 · 54.5%High 4 · 18.2%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroid compared to single course for the fetus/neonate/infant
Population: the fetus/neonate/infant
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
A1: Fetal or neonatal or infant death (< 1 year of age) – all fetuses randomised Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroid vs single course | RR 0.95 [0.73, 1.24] | 10 studies · 5849 participants | Moderate Downgraded: imprecision |
A5: Respiratory distress syndrome – all fetuses randomised Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroid vs single course | RR 0.82 [0.74, 0.9] | 9 studies · 3540 participants | High |
A7: Severe lung disease – all fetuses randomised Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroid vs single course | RR 0.83 [0.72, 0.97] | 6 studies · 4955 participants | Moderate Downgraded: inconsistency |
A8: Chronic lung disease – all fetuses randomised Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroid vs single course | RR 1 [0.83, 1.22] | 9 studies · 5661 participants | High |
A9: Severe intraventricular haemorrhage (grade 3 or 4) – all fetuses randomised Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroid vs single course | RR 1.13 [0.69, 1.86] | 7 studies · 5066 participants | Moderate Downgraded: imprecision |
A11: Necrotising enterocolitis – all fetuses randomised Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroid vs single course | RR 0.84 [0.59, 1.22] | 9 studies · 5736 participants | Moderate Downgraded: imprecision |
A12: Composite of serious outcomes– all fetuses randomised Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroid vs single course | RR 0.88 [0.8, 0.97] | 9 studies · 5736 participants | Moderate Downgraded: inconsistency |
Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids compared to single course for the woman
Population: the woman
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
B1: Maternal death – all women Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | RR 0.32 [0.01, 7.81] | 1 study · 437 participants | Low Downgraded: imprecision |
B2: Maternal sepsis – an all women Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | RR 1.13 [0.93, 1.39] | 8 studies · 4666 participants | Moderate Downgraded: imprecision |
B3: Caesarean section – an all women Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | RR 1.03 [0.98, 1.09] | 8 studies · 4266 participants | Moderate Downgraded: inconsistency |
B4: Discontinuation of therapy due to maternal adverse effects – an all women Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | no estimate extracted | 1 study · 485 participants | Low Downgraded: imprecision |
Adverse effects of corticosteroids Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | no estimate extracted | 2 studies · 1477 participants | Low Downgraded: inconsistency |
Admission to the intensive care unit ‐ not reported Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | no estimate extracted | NR | No studies |
Breastfeeding at hospital discharge ‐ not reported Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | no estimate extracted | NR | No studies |
Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids compared to single course for the child aged 2 to < 5 years
Population: the child
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
C1: Total deaths (after randomisation) up to early childhood Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | RR 1.06 [0.81, 1.4] | 5 studies · 4565 participants | Moderate Downgraded: imprecision |
C2: Neurodevelopmental impairment at early childhood Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | RR 0.97 [0.85, 1.1] | 4 studies · 3616 participants | High |
C3: Survival free of neurodevelopmental impairment at early childhood Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | RR 1.01 [0.98, 1.04] | 4 studies · 3845 participants | High |
C4: Survival free of major neurodevelopmental impairment atearly childhood Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | RR 1.02 [0.98, 1.05] | 3 studies · 1816 participants | Moderate Downgraded: inconsistency |
Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids compared to single course for the child in mid‐ to late childhood (5 to < 18 years of age)
Population: the child
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
D1: Total deaths (after randomisation) up to mid‐ to later childhood Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | RR 0.93 [0.69, 1.26] | 2 studies · 2874 participants | Moderate Downgraded: imprecision |
D2: Neurocognitive impairment atmid‐ to later childhood Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | RR 0.96 [0.72, 1.29] | 1 study · 897 participants | Low Downgraded: risk of bias, imprecision |
D3: Survival free of neurocognitive impairment atmid‐ to later childhood Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | RR 1.01 [0.95, 1.08] | 1 study · 963 participants | Moderate Downgraded: risk of bias |
D4: Survival free of major neurocognitive impairment atmid‐ to later childhood Summary of findings table ‐ Repeat dose(s) of prenatal corticosteroids vs single course | RR 1 [0.97, 1.04] | 2 studies · 2682 participants | Moderate Downgraded: risk of bias |