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• W2068768687 abstract "We welcome publication of the MACS trial report.1Murphy KE Hannah ME Willan AR et al.for the MACS Collaborative GroupMultiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial.Lancet. 2008; 372: 2143-2151Summary Full Text Full Text PDF PubMed Scopus (286) Google Scholar What concerns us is that, in line with many earlier trials of single-course and with all trials of multiple-course antenatal steroids for preterm birth, infants with chorioamnionitis were excluded. In very preterm infants the incidence of clinical chorioamnionitis is around 10–30%. Thus, exclusion of these infants leads to an important reduction in external validity. Moreover, a growing body of evidence suggests that an opportunity is being missed when withholding antenatal steroids from infants with chorioamnionitis. In infants with signs of intrauterine inflammation, including clinical and histological chorioamnionitis, antenatal steroid administration is associated with reductions in respiratory distress syndrome, patent ductus arteriosus, systemic inflammatory response syndrome, severe cerebral lesions, cerebral palsy, and neonatal mortality.2Been JV Zimmermann LJ Histologic chorioamnionitis and respiratory outcome in preterm infants.Arch Dis Child Fetal Neonatal Ed. 2009; (published online Jan 8.)https://doi.org/10.1136/adc.2008.150458Crossref PubMed Scopus (129) Google Scholar, 3Kent A Lomas F Hurrion E Dahlstrom JE Antenatal steroids may reduce adverse neurological outcome following chorioamnionitis: neurodevelopmental outcome and chorioamnionitis in premature infants.J Paediatr Child Health. 2005; 41: 186-190Crossref PubMed Scopus (56) Google Scholar, 4Locatelli A Ghidini A Assi F Andreani M Malguzzi S Paterlini G Which factors affect the occurrence of severe cerebral lesions in preterm neonates who are born with intrauterine infection?.Am J Obstet Gynecol. 2008; 199: e1-e5Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar In a prospective cohort (n=301), we saw similar reductions in respiratory distress syndrome, intraventricular haemorrhage, ductus ligation, and mortality after antenatal steroids in infants with chorioamnionitis (unpublished data). Additionally, a meta-analysis of single-course studies showed particular benefit in infants with preterm, prelabour rupture of membranes, without an adverse effect on maternal outcome.5Roberts D Dalziel S Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.Cochrane Database Syst Rev. 2006; 3 (CD004454.)Google Scholar Thus, whereas a general concern exists around antenatal steroid administration when intrauterine infection is suspected, recent studies leave no grounds for this fear and even seem to support this practice. We are in need of randomised trials of antenatal steroids that either focus on infants with chorioamnionitis or provide specific subgroup analysis for this group. Only then will we be able to validate or decline the generally restricted use of antenatal steroids in the setting of suspected intrauterine inflammation. We declare that we have no conflict of interest. Antenatal corticosteroids to prevent preterm birth – Authors' replyPer Ashorn notes a 0·4-week difference in gestational age at birth between the placebo and the antenatal corticosteroid groups and questions whether this could be responsible for the differences found in birthweight and head circumference. The difference in gestational age at birth could possibly account for some of the differences in birthweight and head circumference, but not all of it, since more infants in the antenatal corticosteroid group than in the placebo group were small for gestational age (less than 10th centile) at birth (17% vs 14%, respectively). Full-Text PDF" @default.
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• W2068768687 date "2009-03-01" @default.
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• W2068768687 title "Antenatal corticosteroids to prevent preterm birth" @default.
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• W2068768687 doi "https://doi.org/10.1016/s0140-6736(09)60543-2" @default.
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