CONCLUSION
This comprehensive NMA confirmed
that corticosteroids were mostly effective for neonatal and child
relevant outcomes compared with placebo or no treatment. There was no
important difference between corticosteroids on neonatal death,
neurodevelopmental disability, IVH and birthweight. Low to moderate-CE
suggest that dexamethasone may reduce chorioamnionitis, and foetal death
but may increase puerperal sepsis and RDS. However, the 95%CI indicates
both beneficial and detrimental effects for these outcomes. The opposing
direction of these outcomes does not allow to derive recommendations
about what corticosteroid should be used and large well designed RCTs
are warranted to improve the certainty of evidence. Ideally, they should
represent low resource settings and also evaluate the best schemes of
administration. Individual participant data meta-analysis could help to
answer these questions. In the meantime, monitoring short-term and
long-term health outcomes, including neurodevelopmental disability will
be important.
Since there is no robust evidence on which corticosteroid should be
prescribed, decisions should be based on availability, costs,
opportunity, and facilities. Shared decision-making would help patients
to take their choices when facing this scenario.