Healthcare organisations and services should have policies and protocols in place for antenatal steroid treatment because the cost and duration of neonatal intensive care is reduced following corticosteroid therapy.4 It is therefore prudent to initiate antenatal steroid treatment in all high risk cases.
The optimal treatment-delivery interval for administration of antenatal corticosteroids is more than 24 hours but fewer than seven days after the start of treatment.4 Beyond this duration there is insufficient evidence of benefit.
Women may be advised that the use of a single course of antenatal corticosteroids does not appear to be associated with any significant maternal or fetal adverse effects.4 Corticosteroid therapy is contraindicated if a woman suffers from systemic infection including tuberculosis. Caution is advised if suspected chorioamnionitis is diagnosed.4 This is because steroids may mask the signs of chorioamnionitis as well as delay intervention.
Betamethasone is the steroid of choice to enhance lung maturation. Recommended therapy involves two doses of betamethasone 12mg, given intramuscularly 24 hours apart or four doses of dexamthasone 6mg, given intramuscularly 12 hours apart.4 However, newer evidence is to the contrary. Ten trials (1089 women and 1161 infants) were included. Dexamethasone decreased the incidence of intraventricular haemorrhage compared with betamethasone (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.21 to 0.92; four trials, 549 infants). No statistically significant differences were seen for other primary outcomes including respiratory distress syndrome, bronchopulmonary dysplasia, severe intraventricular haemorrhage, periventricular leukomalacia, perinatal death, or mean birthweight.7 Therefore, now dexamethasone has been found to be superior to bethamethasone.
