Clinical Health Updates

Repeated antenatal doses of steroids reduces neonatal morbidity (ACTORDS)

Clinical Question:
Do repeated doses of steroids reduce neonatal morbidity?

Bottom Line:
Exposure to repeat doses of antenatal corticosteroids reduces neonatal morbidity. Pending long-term outcome results, the short-term benefits for the babies in our study support the use of repeat doses of corticosteroids in women who remain at risk of very preterm birth 7 or more days after an initial course.

Crowther CA, Haslam RR, Hiller JE, Doyle LW, Robinson JS, for the Australasian Collaborative Trial of Repeat Doses of Steroids (ACTORDS) Study Group.Neonatal respiratory distress syndrome after repeat exposure to antenatal corticosteroids: a randomised controlled trial. Lancet 2006;367:1913-1919.

Study Design:
Randomized controlled trial (double-blinded)

Pregnant women at 32 weeks’ gestation or less (including women carrying twins or triplets) who had received a dose of corticosteroids at least 7 days before and who were judged to be at continued risk for premature delivery were randomly assigned (by concealed allocation) to receive weekly intramuscular injections of 7.8 mg betamethasone sodium phosphate and 6 mg betamethasone acetate (Celestone Chronodose; n = 489 women, 568 babies) or saline placebo (n = 493 women, 578 babies). The researchers excluded women who were in the second stage of labor, had chorioamnionitis needing urgent delivery, had mature lung development, or had been judged to require further corticosteroid therapy. The main outcomes were evaluated by intention to treat, but the authors don’t say if these outcomes were assessed by researchers masked to treatment assignment. The researchers included 100% of the women and babies in the analysis. Overall neonatal mortality was similar in each group (4.6% in the steroid-treated group, 4.8% in the saline group). However, only 33% of the steroid-treated infants developed respiratory distress syndrome compared with 41% of the control infants (number needed to treat=14; 95% CI, 8 – 50).