Antenatal corticosteroid administration before elective caesarean section at term to prevent neonatal respiratory morbidity: a randomized controlled trial

ObjectiveTo assess the effect of prophylactic corticosteroid administration before elective caesarean section at term (between 38 and 38+6 weeks) in reducing neonatal respiratory morbidity and admission to a neonatal intensive care unit (NICU) with respiratory complications.MethodsWomen in this study (n = 1290) were randomized into two groups: the dexamethasone group (n = 645) and the control group (n = 645). Women in the dexamethasone group received three doses of intramuscular dexamethasone 8 mg, 12 h apart, 48 h before caesarean section. Women in the control group received intramuscular saline as a placebo in the same dosage as the dexamethasone group.Primary outcomeComparison of NICU admission rates and the occurrence of neonatal respiratory morbidity between the two groups.ResultsThe NICU admission rate for respiratory morbidity was significantly lower in the dexamethasone group compared with the control group [10/616 (1.6%) vs 24 (3.9%), respectively; p = 0.014]. Antenatal administration of dexamethasone was significantly associated with almost 2.5-fold reduction in the risk of NICU admission for respiratory morbidity (relative risk 0.41, 95% confidence interval 0.2–0.86; number needed to treat ≅43).ConclusionAntenatal corticosteroids reduce the incidence of NICU admission with respiratory morbidity after elective caesarean section at term.