A Cochrane review included 1 study with a total of 942 women. The study compared prophylactic administration of betamethasone (two intramuscular doses of betamethasone in the 48 hours before delivery) versus usual treatment without steroids in term elective caesarean sections. Prophylactic betamethasone appeared to significantly decrease the risk of admission to neonatal special care units (all levels) (RR 0.45 95% CI 0.22 to 0.90), and particularly to neonatal intensive care units for respiratory morbidity (RR 0.15, 95% CI 0.03 to 0.64). Prophylactic bethamethasone did not significantly reduce the overall rate of admission to neonatal special care (all levels) for any indication (i.e. respiratory and non-respiratory indications) (RR 0.81, 95% CI 0.49 to 1.33).
No statistically significant reduction was found in the incidence of neonatal respiratory distress syndrome (RR 0.32, 95% CI 0.07 to 1.58), transient tachypnoea of the newborn (RR 0.52, 95% CI 0.25 to 1.11), need for mechanical ventilation (RR 4.07, 95% CI 0.46 to 36.27) and length of stay in neonatal intensive care unit ((MD) -2.14 days, 95% CI -5.58 to 1.30). There were no reported events of neonatal sepsis, perinatal deaths or maternal trauma infection, therefore results on these outcomes are non-estimable.
Comment: The quality of evidence is downgraded by study quality (lack of blinding) and by imprecise results (few outcome events).