SynthesisInternational journal of epidemiology2010
Antenatal steroids in preterm labour for the prevention of neonatal deaths due to complications of preterm birth.
Synthesis in International journal of epidemiology, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
60 citing papers in PubMed, 5 syntheses or guidelines pooled it, 152 citations in OpenAlex.
- Assessing the quality of antenatal corticosteroids in low- and middle-income countries: A systematic review.PloS one · 2020Pooled it
- Pooled it
- Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review.Lancet (London, England) · 2012Pooled it
- Care during labor and birth for the prevention of intrapartum-related neonatal deaths: a systematic review and Delphi estimation of mortality effect.BMC public health · 2011Pooled it
- Preterm birth.BMJ clinical evidence · 2011Pooled it
- Trial
- The global network antenatal corticosteroids trial: impact on stillbirth.Reproductive health · 2016Trial
- Use of antenatal corticosteroids at health facilities and communities in low-and-middle income countries.Reproductive health · 2016Trial
- The Antenatal Corticosteroids Trial (ACT)'s explanations for neonatal mortality - a secondary analysis.Reproductive health · 2016Trial
- The Antenatal Corticosteroids Trial (ACT): a secondary analysis to explore site differences in a multi-country trial.Reproductive health · 2016Trial
- Effectiveness of intratracheal salbutamol in addition to surfactant on the clinical course of newborns with respiratory distress syndrome: a clinical trial.Italian journal of pediatrics · 2016Trial
- A population-based, multifaceted strategy to implement antenatal corticosteroid treatment versus standard care for the reduction of neonatal mortality due to preterm birth in low-income and middle-income countries: the ACT cluster-randomised trial.Lancet (London, England) · 2015Trial
- Causes of Death Among Stillbirths and Children Aged <5 Years in Africa and South Asia - Child Health and Mortality Prevention Surveillance, Seven Countries, 2016-2024.Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002) · 2026Article
- Gestational age-specific effects of antenatal corticosteroids on early physiologic vulnerability and neonatal outcomes.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Antenatal betamethasone impairs markers of cardiac development and function in near-term lambs.Experimental physiology · 2026Article
- Article
- Evaluation of intratracheal salbutamol effects in addition to surfactant in the clinical course of premature neonates with respiratory distress syndrome.Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences · 2023Article
- Article
- Article
- Respiratory Interventions for Preterm Infants in LMICs: A Prospective Study From Cape Town, South Africa.Frontiers in global women's health · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn high-income countries, administration of antenatal steroids is standard care for women with anticipated preterm labour. However, although >1 million deaths due to preterm birth occur annually, antenatal steroids are not routine practice in low-income countries where most of these deaths occur.
objectivesTo review the evidence for and estimate the effect on cause-specific neonatal mortality of administration of antenatal steroids to women with anticipated preterm labour, with additional analysis for the effect in low- and middle-income countries.
methodsWe conducted systematic reviews using standardized abstraction forms. Quality of evidence was assessed using an adapted GRADE approach. Existing meta-analyses were reviewed for relevance to low/middle-income countries, and new meta-analysis was performed.
resultsWe identified 44 studies, including 18 randomised control trials (RCTs) (14 in high-income countries) in a Cochrane meta-analysis, which suggested that antenatal steroids decrease neonatal mortality among preterm infants (<36 weeks gestation) by 31% [relative risk (RR) = 0.69; 95% confidence interval (CI) 0.58-0.81]. Our new meta-analysis of four RCTs from middle-income countries suggests 53% mortality reduction (RR = 0.47; 95% CI 0.35-0.64) and 37% morbidity reduction (RR = 0.63; 95% CI 0.49-0.81). Observational study mortality data were consistent. The control group in these equivalent studies was routine care (ventilation and, in many cases, surfactant). In low-income countries, many preterm babies currently receive little or no medical care. It is plausible that antenatal steroids may be of even greater effect when tested in these settings.
conclusionsBased on high-grade evidence, antenatal steroid therapy is very effective in preventing neonatal mortality and morbidity, yet remains at low coverage in low/middle-income countries. If fully scaled up, this intervention could save up to 500 000 neonatal lives annually.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.