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

doi:10.1136/bmj.38547.416493.06

BMJ, doi: 10.1136/bmj.38547.416493.06, (Published 22 August 2005)

PAPERS

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

Peter Stutchfield ¹^*, Rhiannon Whitaker ², Ian Russell ², 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 LL57 2PX

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

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

DesignMulticentre pragmatic randomised trial.

Setting 10 maternityunits.

Participants 998 consenting women randomised at decisionto deliver by elective caesarean section; 503 randomised totreatment group.

Interventions The treatment group received twointramuscular doses of 12 mg betamethasone in the 48 hours beforedelivery. The control group received treatment as usual.

Outcomemeasures The primary outcome was admission to special care babyunit with respiratory distress. Secondary outcomes were severityof respiratory distress and level of care in response.

ResultsSex, birth weight, and gestation were not different betweenthe two groups. Of the 35 babies admitted to special baby unitswith respiratory distress, 24 were in the control group and11 in the intervention group (P=0.02). The incidence of admissionwith respiratory distress was 0.051 in the control group and0.024 in the treatment group (relative risk 0.46, 95% confidenceinterval 0.23 to 0.93). The incidence of transient tachypnoeaof the newborn was 0.040 in the control group and 0.021 in thetreatment group (0.54, 0.26 to 1.12). The incidence of respiratorydistress syndrome was 0.011 in the control group and 0.002 inthe treatment group (0.21, 0.03 to 1.32).

Conclusions Antenatalbetamethasone and delaying delivery until 39 weeks both reduceadmissions to special care baby units with respiratory distressafter elective caesarean section at term.

(Accepted 27 June 2005)

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