The Use of Antenatal Dexamethasone in Late Preterm and Term Pregnancies to Improve Neonatal Morbidity and Mortality: A Systematic Review and Meta-Analysis

Alexandros Samouilidis; Eleftherios T Beltsios; Georgios Mavrovounis; Antonis Adamou; Ioannis Belios; Alexandros Hadjivasilis; Ioannis Pantazopoulos; Aris P Agouridis

doi:10.7759/cureus.27865

The Use of Antenatal Dexamethasone in Late Preterm and Term Pregnancies to Improve Neonatal Morbidity and Mortality: A Systematic Review and Meta-Analysis

Cureus. 2022 Aug 10;14(8):e27865. doi: 10.7759/cureus.27865. eCollection 2022 Aug.

Authors

Alexandros Samouilidis¹, Eleftherios T Beltsios², Georgios Mavrovounis², Antonis Adamou³, Ioannis Belios², Alexandros Hadjivasilis⁴, Ioannis Pantazopoulos², Aris P Agouridis¹

Affiliations

¹ Internal Medicine, European University Cyprus, Nicosia, CYP.
² Emergency Medicine, University of Thessaly, Larissa, GRC.
³ Radiology, University of Thessaly, Larissa, GRC.
⁴ Epidemiology and Public Health, Cyprus University of Technology, Limassol, CYP.

Abstract

There are no acceptable worldwide recommendations regarding the use of dexamethasone in late-preterm newborns delivered either vaginally or via cesarean section and term gestation that are performed via cesarean section. The present study aims to compare the effectiveness of antenatal intramuscular dexamethasone versus placebo/no-treatment in reducing neonatal respiratory complications in high-risk for imminent preterm birth in late preterm pregnancies and term pregnancies undergoing elective cesarean section. The PubMed, Scopus, and Cochrane Library databases were searched to assess the effectiveness of dexamethasone during late preterm and term gestation. The last literature search was performed on March 20th, 2022. Randomized controlled trials compared antenatal dexamethasone administration with placebo or no treatment. The outcomes of interest were: the incidence of Respiratory Distress Syndrome; Transient Tachypnea of the Newborn, Neonatal Intensive Care Unit admissions; and the need for ventilatory support or mechanical ventilation. A standardized data form and three independent investigators performed the data extraction. Ten RCTs fulfilled our inclusion criteria. No statistically significant difference was found regarding all of the outcomes in the 34th-36th gestational week group. In the >37th gestational week group, a statistically significant difference was found regarding the incidence of RDS [RR (95% CI); p-value: 0.56 (0.36, 0.87); 0.01], TTN [RR (95% CI); p-value: 0.54 (0.42, 0.71); <0.00001], need for ventilatory support [RR (95% CI); p-value: 0.71 (0.52, 0.96); 0.03] and need for mechanical ventilation [RR (95% CI); p-value: 0.56 (0.33, 0.95); 0.03]. To conclude, the antenatal administration of dexamethasone can be considered to prevent neonatal complications and reduce perinatal morbidity in term pregnancies.

Keywords: antenatal dexamethasone; cesarean section; dexamethasone; late preterm pregnancies; meta-analysis; neonatal intensive care unit; neonatal respiratory distress; preterm birth; term pregnancies; transient tachypnea of newborn.

Publication types

Review