New Evidence Available
Updated Recommendation
A new evidence synthesis was published:2022, WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes.
View latest version (2022)Bibliographic Info
GuidelineWHO recommendations on interventions to improve preterm birth outcomes
Year of Publication2015
Issuing InstitutionWorld Health Organization
Recommendation
Status
Retired
Recommended in favor
Conditional
A single repeat course of antenatal corticosteroid is recommended if preterm birth does not occur within 7 days after the initial dose, and a subsequent clinical assessment demonstrates that there is a high risk of preterm birth in the next 7 days.
Notes and Remarks
- 1.The GDG acknowledged the lack of evidence on further reduction of neonatal mortality with the use of repeat corticosteroids. However, the group placed its emphasis on the associated further reduction in the respiratory morbidity and less surfactant use (which could save costs) and placed lower value on the small reduction in neonatal birth weight, and therefore recommended a single repeat course of steroid. Given that there are likely to be variations in these values across health system settings, the GDG lowered the strength of the recommendation and made it conditional.
- 2.A single course in this context refers to a full dose of antenatal corticosteroid as recommended in this guideline.
- 3.This recommendation should only be applied to women between 24 and 34 weeks of gestation.
- 4.The GDG noted that only betamethasone was tested in this context, but concluded that there were no reasons not to extend the recommendation to dexamethasone. The group also noted the variations in the number of courses and doses of betamethasone used, but agreed that the recommendation should align with the previous recommendation on antenatal corticosteroid regimens.