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No hubo efectos beneficiosos obvios en: enfermedad pulmonar crónica (CR promedio 0,86; IC del 95%: 0,42 a 1,79; participantes = 818; estudios = 6; Tau² = 0,38; I² = 65%); peso promedio al nacer (g) (DM -18,47; IC del 95%: -40,83 a 3,90; participantes = 6182; estudios = 16; calidad moderada); muerte en la infancia (CR 0,68; IC del 95%: 0,36 a 1,27; participantes = 1010; estudios = 4); retraso del neurodesarrollo en la infancia (CR 0,64; IC del 95%: 0,14 a 2,98; participantes = 82; estudios = 1); o muerte en la edad adulta (CR 1,00; IC del 95%: 0,56 a 1,81; participantes = 988; estudios = 1).

In a landmark paper, Liggins and Howie showed that a single course of antenatal corticosteroid therapy administered to women at risk for preterm delivery (PTD) reduced the incidence and severity of respiratory distress syndrome (RDS) and mortality in offspring [ 1 ]. Over two dozen randomized trials have confirmed these findings [ 2 ]. Subsequent trials have also shown that antenatal corticosteroid therapy improves circulatory stability in preterm neonates, resulting in lower rates of intraventricular hemorrhage (IVH) and necrotizing enterocolitis compared with unexposed preterm neonates.

For this update, 12 trials (1557 women and 1661 infants) were included. Dexamethasone was associated with a reduced risk of intraventricular haemorrhage (IVH) compared with betamethasone ( risk ratio ( RR ) , 95% confidence interval ( CI ) to ; four trials, 549 infants). No statistically significant differences were seen for other primary outcomes: respiratory distress syndrome (RDS) ( RR , 95% CI to ; five trials, 753 infants) and perinatal death (neonatal death RR , 95% CI to ; four trials, 596 infants). Similarly, very few differences were seen for secondary outcomes such as rate of admission to the neonatal intensive care unit (NICU) although in one trial , those infants exposed to dexamethasone, compared with betamethasone, had a significantly shorter length of NICU admission ( mean difference ( MD ) - days, 95% CI - to -; 70 infants). Results for biophysical parameters were inconsistent, but mostly no clinically important differences were seen.

Dexamethasone and betamethasone are the most commonly-used antenatal corticosteroids for lung maturation. WHO is currently updating its guidelines on prevention and management of preterm birth. These are expected to be published in 2015. In 2012, the UN Commission on Life-saving Commodities for Women and Children recommended that countries make both drugs available to all those in need. Dexamethasone is included on the WHO Model List of Essential Medicines (which serves as a model for the selection and use of medicines in countries). Nifedipine is a relatively cheap, simple to administer, tocolytic drug. It is also included on the WHO Essential Medicines List. The study’s authors emphasize that dexamethasone and betamethasone should be included on national essential medicines lists.

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Dexamethasone and betamethasone are the most commonly-used antenatal corticosteroids for lung maturation. WHO is currently updating its guidelines on prevention and management of preterm birth. These are expected to be published in 2015. In 2012, the UN Commission on Life-saving Commodities for Women and Children recommended that countries make both drugs available to all those in need. Dexamethasone is included on the WHO Model List of Essential Medicines (which serves as a model for the selection and use of medicines in countries). Nifedipine is a relatively cheap, simple to administer, tocolytic drug. It is also included on the WHO Essential Medicines List. The study’s authors emphasize that dexamethasone and betamethasone should be included on national essential medicines lists.

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