Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial

doi:10.1136/bmj.38547.416493.06

BMJ 2005;331:662 (24 September), doi:10.1136/bmj.38547.416493.06 (published 22 August 2005)

Paper

Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial

Peter Stutchfield, consultant paediatrician¹, Rhiannon Whitaker, trial statistician², Ian Russell, director², on behalf of the Antenatal Steroids for Term Elective Caesarean Section (ASTECS) Research Team

¹ Conwy and Denbighshire NHS Trust, Glan Clwyd Hospital, Rhyl, Denbighshire LL18 5UJ, ² Institute of Medical and Social Care Research, University of Wales Bangor LL572PX

Correspondence to: P Stutchfield DrPeter.Stutchfield{at}cd-tr.wales.nhs.uk

Objective To test whether steroids reduce respiratory distressin babies born by elective caesarean section at term.

Design Multicentre pragmatic randomised trial.

Setting 10 maternity units.

Participants 998 consenting women randomised at decision todeliver by elective caesarean section; 503 randomised to treatmentgroup.

Interventions The treatment group received two intramusculardoses of 12 mg betamethasone in the 48 hours before delivery.The control group received treatment as usual.

Outcome measures The primary outcome was admission to specialcare baby unit with respiratory distress. Secondary outcomeswere severity of respiratory distress and level of care in response.

Results Sex, birth weight, and gestation were not differentbetween the two groups. Of the 35 babies admitted to specialbaby units with respiratory distress, 24 were in the controlgroup and 11 in the intervention group (P = 0.02). The incidenceof admission with respiratory distress was 0.051 in the controlgroup and 0.024 in the treatment group (relative risk 0.46,95% confidence interval 0.23 to 0.93). The incidence of transienttachypnoea of the newborn was 0.040 in the control group and0.021 in the treatment group (0.54, 0.26 to 1.12). The incidenceof respiratory distress syndrome was 0.011 in the control groupand 0.002 in the treatment group (0.21, 0.03 to 1.32).

Conclusions Antenatal betamethasone and delaying delivery until39 weeks both reduce admissions to special care baby units withrespiratory distress after elective caesarean section at term.

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Rapid Responses:

Read all Rapid Responses

A physiological approach to reducing neonatal morbidity in elective Caesarean Section: David J R Hutchon
bmj.com, 24 Aug 2005 [Full text]
Commentary on antenatal betemethasone at term: David J Garry
bmj.com, 27 Aug 2005 [Full text]
confusing trials: nick brown
bmj.com, 23 Sep 2005 [Full text]
There is no longer any such thing as caesarean section without medical reasons.: Jonathan H West
bmj.com, 24 Sep 2005 [Full text]
reducing SCBU addmissions for elective C Section: Chris J Griffin
bmj.com, 28 Sep 2005 [Full text]
Caution is still needed.: Celestin O. Selo-Ojeme
bmj.com, 3 Oct 2005 [Full text]
Why would antenatal steroids prevent transient tachypnoea of the newborn?: Humberto Fiori
bmj.com, 4 Oct 2005 [Full text]
No benefit for steroids: David J R Hutchon
bmj.com, 7 Dec 2005 [Full text]
A clearer explanation of no benefit for steroids: David JR Hutchon
bmj.com, 8 Dec 2005 [Full text]
Elective Caesarean Section at Term: Peter Roy Stutchfield, et al.
bmj.com, 9 Dec 2005 [Full text]
An answer please: David J R Hutchon
bmj.com, 10 Dec 2005 [Full text]
Elective Caesarean Section at Term -References Rapid Response 9th December: Peter Roy Stutchfield, et al.
bmj.com, 11 Dec 2005 [Full text]
Informed consent for cord clamping?: David J R Hutchon
bmj.com, 12 Dec 2005 [Full text]
Admissions to Special Care Baby Unit in the Antenatal Steroids for Term Elective Caesarean Section Trial: Peter Roy Stutchfield, et al.
bmj.com, 14 Dec 2005 [Full text]
A trial of physiological delivery at Caesarean: David J R Hutchon
bmj.com, 19 Dec 2005 [Full text]
Increased risk of neanatal death with corticosteroids after 36 weeks: David JR Hutchon
bmj.com, 23 Oct 2006 [Full text]
Reduction in neonatal death with corticosteroids: Peter R Stutchfield, et al.
bmj.com, 14 Dec 2006 [Full text]
Not an intentional error: David JR Hutchon
bmj.com, 18 Dec 2006 [Full text]