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Antenatal corticosteroids for neonates born before 25 Weeks—A systematic review and meta-analysis

BACKGROUND: Efficacy of antenatal corticosteroids before 25 weeks of gestation is unclear. OBJECTIVE: To assess and compare neonatal outcomes following ANC exposure at 22, 23 and 24 weeks of gestation by conducting systematic review and meta- analysis. METHODS: A systematic review of randomised cont...

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Autores principales: Deshmukh, Mangesh, Patole, Sanjay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423600/
https://www.ncbi.nlm.nih.gov/pubmed/28486556
http://dx.doi.org/10.1371/journal.pone.0176090
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author Deshmukh, Mangesh
Patole, Sanjay
author_facet Deshmukh, Mangesh
Patole, Sanjay
author_sort Deshmukh, Mangesh
collection PubMed
description BACKGROUND: Efficacy of antenatal corticosteroids before 25 weeks of gestation is unclear. OBJECTIVE: To assess and compare neonatal outcomes following ANC exposure at 22, 23 and 24 weeks of gestation by conducting systematic review and meta- analysis. METHODS: A systematic review of randomised controlled trials (RCT) and non-RCTs reporting on neonatal outcomes after exposure to ANC up to 24(6) weeks of gestation using the Cochrane systematic review methodology. Databases Pubmed, CINAHL, Embase, Cochrane Central library, and online abstracts of conference proceedings including the Pediatric Academic Society (PAS) were searched in Feb 2017. Primary outcome was in-hospital mortality defined as death before discharge during the first admission. Secondary outcomes included severe intraventricular hemorrhage (IVH> grade III and IV)/or periventricular leukomalacia (PVL), necrotising enterocolitis (NEC >stage II) and chronic lung disease (CLD). Meta-analysis was performed using a random-effects model. The level of evidence (LOE) was summarised using the GRADE guidelines. MAIN RESULTS: There were no RCTs; 8 high quality non-RCTs were included in the review. Meta-analysis showed reduction in mortality [N = 10109; OR = 0.47(0.39–0.56), p<0.00001; LOE: Moderate] and severe IVH and PVL [N = 5084; OR = 0.71(0.61–0.82), p<0.00001; LOE: Low] after exposure to ANC in neonates born <25 weeks. There was no significant difference in CLD [N = 4649; OR = 1.19(0.85–1.65) p = 0.31; LOE: Low] and NEC [N = 5403; OR = 0.95 (0.76–1.19) p = 0.65; LOE: Low]. Mortality was comparable in neonates born at 22, 23 or 24 weeks. CONCLUSION: Moderate to low quality evidence indicates that exposure to ANC is associated with reduction in mortality and IVH/or PVL in neonates born before 25 weeks.
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spelling pubmed-54236002017-05-15 Antenatal corticosteroids for neonates born before 25 Weeks—A systematic review and meta-analysis Deshmukh, Mangesh Patole, Sanjay PLoS One Research Article BACKGROUND: Efficacy of antenatal corticosteroids before 25 weeks of gestation is unclear. OBJECTIVE: To assess and compare neonatal outcomes following ANC exposure at 22, 23 and 24 weeks of gestation by conducting systematic review and meta- analysis. METHODS: A systematic review of randomised controlled trials (RCT) and non-RCTs reporting on neonatal outcomes after exposure to ANC up to 24(6) weeks of gestation using the Cochrane systematic review methodology. Databases Pubmed, CINAHL, Embase, Cochrane Central library, and online abstracts of conference proceedings including the Pediatric Academic Society (PAS) were searched in Feb 2017. Primary outcome was in-hospital mortality defined as death before discharge during the first admission. Secondary outcomes included severe intraventricular hemorrhage (IVH> grade III and IV)/or periventricular leukomalacia (PVL), necrotising enterocolitis (NEC >stage II) and chronic lung disease (CLD). Meta-analysis was performed using a random-effects model. The level of evidence (LOE) was summarised using the GRADE guidelines. MAIN RESULTS: There were no RCTs; 8 high quality non-RCTs were included in the review. Meta-analysis showed reduction in mortality [N = 10109; OR = 0.47(0.39–0.56), p<0.00001; LOE: Moderate] and severe IVH and PVL [N = 5084; OR = 0.71(0.61–0.82), p<0.00001; LOE: Low] after exposure to ANC in neonates born <25 weeks. There was no significant difference in CLD [N = 4649; OR = 1.19(0.85–1.65) p = 0.31; LOE: Low] and NEC [N = 5403; OR = 0.95 (0.76–1.19) p = 0.65; LOE: Low]. Mortality was comparable in neonates born at 22, 23 or 24 weeks. CONCLUSION: Moderate to low quality evidence indicates that exposure to ANC is associated with reduction in mortality and IVH/or PVL in neonates born before 25 weeks. Public Library of Science 2017-05-09 /pmc/articles/PMC5423600/ /pubmed/28486556 http://dx.doi.org/10.1371/journal.pone.0176090 Text en © 2017 Deshmukh, Patole http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Deshmukh, Mangesh
Patole, Sanjay
Antenatal corticosteroids for neonates born before 25 Weeks—A systematic review and meta-analysis
title Antenatal corticosteroids for neonates born before 25 Weeks—A systematic review and meta-analysis
title_full Antenatal corticosteroids for neonates born before 25 Weeks—A systematic review and meta-analysis
title_fullStr Antenatal corticosteroids for neonates born before 25 Weeks—A systematic review and meta-analysis
title_full_unstemmed Antenatal corticosteroids for neonates born before 25 Weeks—A systematic review and meta-analysis
title_short Antenatal corticosteroids for neonates born before 25 Weeks—A systematic review and meta-analysis
title_sort antenatal corticosteroids for neonates born before 25 weeks—a systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423600/
https://www.ncbi.nlm.nih.gov/pubmed/28486556
http://dx.doi.org/10.1371/journal.pone.0176090
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