Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial.

Details

Serval ID
serval:BIB_3A9250EEC278
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial.
Journal
Lancet
Author(s)
Murphy K.E., Hannah M.E., Willan A.R., Hewson S.A., Ohlsson A., Kelly E.N., Matthews S.G., Saigal S., Asztalos E., Ross S., Delisle M.F., Amankwah K., Guselle P., Gafni A., Lee S.K., Armson B.A.
Working group(s)
MACS Collaborative Group
Contributor(s)
Murphy KE., Amankwah K., Armson BA., El Asztalos, Delisle MF., Gafni A., Guselle P., Hannah ME., Hewson SA., Kelly EN., Lee SK., Matthews SG., Ohlsson A., Ross S., Rovet J., Saigal S., Sananes R., Schmid I., Willan AR., Kwiatkowski L., Tortorella SM., Bertin MS., Castaldi JL., Deguer C., Klun M., Besegato C., Izbizky G., Vaneri MC., Fustinana CA., Otano L., Palermo MS., Javier Murua E., Montes Valera D., Sampietro H., Monaco A., Savransky R., Dunaiewsky A., Basualdo MN., Andina E., Di Marco I., Rivero M., Feu MC., Garcia S., Aguirre JD., Morales EM., Ayala LE., De Sagastizabal MT. , Abreo G., Uranga A., de Lourdes Martin R., Arias C., Abalos Gorostiaga R., Curioni M., Alvarado J., Fuchtner C., Mostajo Flores D., Tonoli Tessari DM. , Madi JM., de Lorenzi DR. , do Carmo Mattana M., Brunstein C., Trapani A.<Suffix>Jr</Suffix> , Schmaltz L., de Souza GR. , de Assis ME. , Melo Melgaco IA. , de Sa RA. , Guerios Bornia R., Demianczuk NN., Penttinen E., Butt K., Hay K., Sandwich V., Armson BA., Vincer M., Allen V., Fanning C., Kulkarni R., Laplante J., Carson GD., Williams S., Holfeld S., Olatunbosun F., Dalton S., Henry A., Haughian J., Moutquin JM., Blouin D., Kocsis Bédard S., Murphy K., Ohlsson A., Kelly E., Jordan A., Shapiro J., Asztalos E., Barrett J., Cohen H., Andrews L., Owen H., Delisle MF., Popovska V., Soanes S., Helewa ME., Kenny-Lodewyks D., Gomez R., Silva K., Figueroa Poblete J., Ferrand P., Belmar C., Vera C., Su QF., Gu W., Liu ZW., Marrugo Flores M., Malabet Santoro C., Ortiz EI., Torres J., Rodriguez A., Hvidman L., Mouritzen A., Vikre-Jørgensen J., Hopp H., Nonnenmacher A., Braig U., Berg C., Bizjak G., Gembruch U., Schwarzer V., Hoyme UB., Bittrich HJ., Oletzky B., Schneider J., Hollwitz B., Oehler K., Dressler F., Kubilay Ertan A., Hentschel J., Mack A., Schmidt W., Faber R., Stepan H., Kuhnert M., Stiller S., Kuschel B., Schneider KT., Zimmermann A., Krause M., Gröbe H., Terzioglu N., Seelbach-Goebel B., Falkert A., Mueller K., Voss H., Major T., Zoárd K., Bartha T., Bea P., Zsadányi J., Nachum Z., Peniakov M., Hallak M., Harlev A., Harel L., Chayen B., Siev S., Samberg I., Wolff L., Sadan O., Elyassi A., Baider C., Kohelet D., Golan A., Mankuta D., Bar-Oz B., Combs D., Rosen DJ., Kaneti HY., Tzachi T., Zausmer J., Maman M., Perri T., Taitelboum S., Simchen M., Shalev G., Goldinfeld M., Levine O., El-Zibdeh MY., Al-Faris LT., Ayyash HA., Saona Ugarte P., Preis K., Domzalska-Popadiuk I., Swiatkowska-Freund M., Janczewska I., Wilczynski J., Krekora M., Kesiak M., Gulczyńska E., Ropacka M., Madejczyk M., Rozycka J., Breborowicz GH., Szymankiewicz M., Borzova N., Posiseeva LV., Khodjaeva Z., Vikhlyaeva E., Palacio M., Salvia D., Botet F., Massanes M., Lopez M., Hösli I., Holzgreve W., Voekt CA., Belhia F., Hohlfeld P., Prince-dit-Clottu E., Beinder E., von Mandach U., Fauchere JC., Roumen FJ., Pieters M., Smits F., Bolaji II., Adiotomre P., Al-Taher H., Barnes H., Abdul-Kadir R., Chi C., Van Someren V., Dexter S., Samelson R., Horgan MJ., Valentini C., Pardanani S., Bebbington M., Chazotte C., Kilpatrick S., Drahos JL., Saldana L., Mount B., Warner B., Wedig K., Lysikiewicz A., Bsat F., Fleming J., Lee A., Hoffman D., Bracken M., Crowley P., Donner A., Duley L., Tyson J.
ISSN
1474-547X (Electronic)
ISSN-L
0140-6736
Publication state
Published
Issued date
2008
Volume
372
Number
9656
Pages
2143-2151
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't Publication Status: ppublish
Abstract
BACKGROUND: One course of antenatal corticosteroids reduces the risk of respiratory distress syndrome and neonatal death. Weekly doses given to women who remain undelivered after a single course may have benefits (less respiratory morbidity) or cause harm (reduced growth in utero). We aimed to find out whether multiple courses of antenatal corticosteroids would reduce neonatal morbidity and mortality without adversely affecting fetal growth.
METHODS: 1858 women at 25-32 weeks' gestation who remained undelivered 14-21 days after an initial course of antenatal corticosteroids and continued to be at high risk of preterm birth were randomly assigned to multiple courses of antenatal corticosteroids (n=937) or placebo (n=921), every 14 days until week 33 or delivery, whichever came first. The primary outcome was a composite of perinatal or neonatal mortality, severe respiratory distress syndrome, intraventricular haemorrhage (grade III or IV), periventricular leucomalacia, bronchopulmonary dysplasia, or necrotising enterocolitis. Analysis was by intention to treat. All patients and caregivers were unaware of the treatment given. This trial is registered as number ISRCTN2654148.
FINDINGS: Infants exposed to multiple courses of antenatal corticosteroids had similar morbidity and mortality to those exposed to placebo (150 [12.9%] vs 143 [12.5%]). Those receiving multiple doses of corticosteroids also weighed less at birth than those exposed to placebo (2216 g vs 2330 g, p=0.0026), were shorter (44.5 cm vs 45.4 cm, p<0.001), and had a smaller head circumference (31.1 cm vs 31.7 cm, p<0.001).
INTERPRETATION: Multiple courses of antenatal corticosteroids, every 14 days, do not improve preterm-birth outcomes, and are associated with a decreased weight, length, and head circumference at birth. Therefore, this treatment schedule is not recommended.
FUNDING: Canadian Institutes of Health Research.
Keywords
Adrenal Cortex Hormones/administration & dosage, Adrenal Cortex Hormones/adverse effects, Adult, Dose-Response Relationship, Drug, Double-Blind Method, Drug Administration Schedule, Female, Gestational Age, Humans, Infant, Newborn, Infant, Newborn, Diseases/mortality, Infant, Newborn, Diseases/prevention & control, Pregnancy, Premature Birth, Treatment Failure
Pubmed
Web of science
Create date
05/03/2009 17:13
Last modification date
20/08/2019 13:30
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