Advances in antenatal corticosteroid application in extremely preterm infants / 国际儿科学杂志

The rate of antenatal corticosteroid application in extremely preterm infants is generally increasing.Although a large number of clinical trials have demonstrated that antenatal corticosteroids significantly reduce mortality and improve prognosis in extremely preterm infants, their application rates still vary widely among different countries and gestational age groups, and the applicability and safety of the clinical applications are controversial.In the treatment of extremely preterm infants in China, the clinical application of antenatal corticosteroids is not widespread.The current situation of antenatal corticosteroid application in extremely preterm infants at home and abroad is reviewed to provide a theoretical basis for the application of antenatal corticosteroid in extremely preterm infants in China.

Effect of the timing of antenatal corticosteroid administration on preterm neonatal outcomes / 中国小儿急救医学

Objective:To investigate the rate and timing of antenatal corticosteroid administration in the singleton preterm infants in our hospital, and explore the relationship between the timing of antenatal corticosteroid administration associated with the causes of preterm delivery and with neonatal outcomes.Methods:The study was a retrospective chart review of clinical data regarding singleton preterm neonates and their mothers from January 2016 and June 2020 at Peking University International Hospital.Optimal administration timing was defined as the first dose of antenatal dexamethasone given ≥48 h and ≤7 d before delivery.Suboptimal administration timing included any antenatal dexamethasone timing(<48 h or >7 d) that did not meet the optimal criteria.Antenatal dexamethasone administration timings were compared among preterm delivery with different causes.The neonatal outcomes of the optimal and suboptimal administration timing groups were compared.Results:The percentage of antenatal dexamethasone use was 89.16%, with 51.35% receiving optimal dexamethasone.Women with premature rupture of membranes were most likely to receive optimal dexamethasone(63.79%), followed by women with complications of pregnancy and other disorders(54.29%). The optimal dexamethasone rate of the women with cervical incompetence and preterm labor was relatively low(20% and 28%, respectively). The incidence of respiratory distress syndrome(RDS) of optimal administration timing group was lower than that in suboptimal administration timing group among neonates at <34 weeks of gestation( P<0.05). But there was no significant difference in the incidence of severe RDS, bronchopulmonary dysplasia, and need for pulmonary surfactant between two groups( P>0.05). The preterm infants with a gestational age between 34 and 34 + 6 weeks had no severe RDS or bronchopulmonary dysplasia.Compared with suboptimal administration timing group, the incidence of RDS and need for pulmonary surfactant of optimal administration timing group did not decrease significantly( P>0.05). Conclusion:The causes of preterm delivery affect the timing of antenatal dexamethasone administration.Optimizing the timing of antenatal dexamethasone administration can reduce the incidence of RDS among neonates less than 34 weeks of gestation.

Effects of antenatal corticosteroids administration on fetoplacental circulation in preterm pregnancies with intrauterine growth restriction and its correlation with perinatal outcome

Background: Antenatal corticosteroid administration in preterm pregnancies is recommended to promote fetal lung maturation. Studies have reported temporary reduction in fetal heart rate, breathing and movements following maternal corticosteroid administration. Authors studied effect of maternal corticosteroid administration on fetoplacental circulation in preterm pregnancies with IUGR and its correlation with perinatal outcome.Methods: Observational study included 77 preterm singleton pregnant women with IUGR. Color doppler day 0 (before betamethasone) of umbilical artery of 77 cases done. All received two doses of 12 mg of betamethasone intramuscularly 24 hours apart. Umbilical artery doppler on day 2 (24 to 48 hours of 1st dose of betamethasone) and day 4 (72 to 96 hours of 1st dose of betamethasone) done. Pulsatility index (PI) of umbilical artery on doppler and Neonatal details of all women noted.Results: On day 2 doppler, 56 (73%) women (Group A) showed decrease in umbilical artery PI while 21 (27%) women (Group B) did not show decrease in umbilical artery PI. Mean umbilical artery PI of 77 cases on day 0 and day 2 were 1.73±0.73 and 1.54±0.76 respectively (p<0.001). Mean Umbilical artery PI values of undelivered 60 cases on day 0, day 2 and day 4 were 1.55±0.61, 1.33±0.55 and 1.47±0.63 respectively (p<0.001). Group B neonates had poorer Apgar scores, higher neonatal complication, longer hospital stay, lesser umbilical pH at birth and higher perinatal mortality rate than Group A neonates.Conclusions: Significant reduction in mean umbilical artery PI observed on day 2 following betamethasone administration (p<0.001), which was maintained till 4th day after 1st dose of betamethasone (p<0.05). Women who showed improvement in umbilical artery pulsatility index following betamethasone administration had a better perinatal outcome as compared to women who did not.

Uso convencional de surfactante en recién nacidos con enfermedad de membrana hialina / Conventional use of surfactant in newborns with hyaline membrane disease

La enfermedad de membrana hialina se debe a la deficiencia de surfactante en los pulmones de los recién nacidos especialmente los menores de 37 semanas de gestación. El manejo materno con corticoides prenatales en este grupo, disminuye la morbimortalidad asociada a esta patología neonatal. Se analiza desde el punto de la evidencia actualmente existente la administración de surfactante a estos prematuros y se revisa el tipo de surfactante a administrar, cuando es el mejor momento para administrarlo, la dosis y la forma de administrarlo.

Hyaline membrane disease is due to surfactant deficiency in the lungs of newborns, especially those younger than 37 weeks gestation. Maternal management with prenatal corticosteroids in this group reduces the morbidity and mortality associated with this neonatal pathology. The administration of surfactant to these preterm infants is analyzed from the point of the currently existing evidence and the type of surfactant to be administered is reviewed, when is the best time to administer it, the dose and the form of administration.

Avaliação do impacto da corticoterapia pré-natal em maternidade-escola de referência / Evaluation of the impact of prenatal therapy with corticosteroids in a referral maternity school

Objetivos. Descrever a frequência do uso do corticosteroide pré-natal e a avaliar a evolução dos recém-nascidos, comparando-se os desfechos com o tipo de corticosteroide usado. Método. Estudo observacional prospectivo do tipo coorte com neonatos de 26 a 34 semanas, nascidos de agosto de 2007 a julho de 2008. A análise dos dados foi feita com o programa SPSS, versão 16 para o Windows, sendo usado ostestes qui ao quadrado, t de Student, razão de risco com intervalo de confiança e regressão logística múltipla. O nível de significância foi 0,05.Resultados. Foram estudadas 187 mães, que conceberam 219 recém-nascidos, das quais 50,3% receberam corticosteroide. A hipertensão ocorreu mais nas gestantes que não receberam corticosteroide. Os recém-nascidos expostos a corticoterapia pré-natal apresentaram significativamente melhores condições ao nascer, menos morbidade como doença da membrana hialina, sepse, hemorragia intraventricular e menor necessidade do uso de ibuprofeno para o fechamento do canal arterial.Não foram observadas diferenças quanto à ocorrência de displasia broncopulmonar, pneumotórax, enterocolite necrosante, uso da ventilação mecânica, uso de surfactante exógeno e morte hospitalar. O corticosteroide pré-natal manteve-se de forma independente quanto ao efeito protetor para melhores condições de nascimento e para a ocorrência da sepse. A betametasona mostrou-se mais eficiente na redução da doença da membrana hialina. Conclusão. Os recém-nascidos submetidos à corticoterapia pré-natal apresentaram melhores condições ao nascer e tiveram menor morbidade.

Objectives. To describe the frequency of prenatal corticosteroids use and to evaluate the newborns development, comparing their outcome to the type of corticosteroids they used. Method. It is a cohort-type observational study with neonates from 26 to 34 weeks that were born from August 2007 to July 2008. The data analysis was accomplished by thesoftware SPSS for Windows, version 16,and the chi-squared test, t-Student test, risk ratio with confidence interval and multiple logistic regressionwere applied.Significance interval was p < 0.05. Results. In the cohort studied, 187 mothers gave birth to 219 newborns, from which 50.3% received corticosteroids. The pregnant women who were not treated showed significantly more hypertension. The newborns exposed to prenatal corticosteroids presented significantly better conditions at birth and a decrease on hyaline membrane disease, sepsis, intraventricular hemorrhage and decreased need of ibuprofen for the closing of the ductus arteriosus patent. There were no significant differences in the occurrence of bronchopulmonary dysplasia, pneumothorax, necrotizing enterocolitis, mechanical ventilation, use of exogenous surfactant and death during the hospitalization period. The prenatal therapywith corticosteroids remained as an independent protective factor for better conditions at birth and avoiding sepsis. The betametasone showed more efficiency in reducing the hyaline membrane disease.Conclusion. The newborns undergone prenatal therapy with corticosteroidsshowed better conditions at birth and thrived with less morbidity.

The effect of time interval between a single course of antenatal corticosteroids and delivery on outcomes in preterm neonates / 대한산부인과학회지

OBJECTIVE: To determine whether the beneficial effects of a single course of antenatal corticosteroids for neonatal morbidity change with time METHODS: A retrospective chart review was performed of women who received a single complete course of antenatal corticosteroid and delivered a viable singleton infant between 26 and 35 weeks of gestation. Patients were divided into 1 of 3 groups on the basis of the interval from first corticosteroid dose to delivery (48 hr~7 days, 8~14 days and > or =15 days). Neonatal morbidities were compared between each groups. RESULTS: Two hundred three pregnancies were included, of which 78 women delivered at 48 hr-7 days, 65 women delivered at 8~14 days and 60 women delivered at > or =15 days. The 3 groups were similar in clinical characteristics and indications for antenatal steroids and delivery. Neonates delivered within 7 days had a lower incidence of receiving ventilatory support for more than 24 hours than 8~14 days group (32.1% vs 50.8%, P=0.023) and > or =15 days group (32.1% vs 51.7%, P=0.02). But there were no significant differences between the groups in ventilator days, surfactant use, oxygen dependency at 36 weeks of gestation, oxygen dependency at 28 days after delivery, intraventricular hemorrhage, necrotizing enterocolitis, sepsis and length of hospital days. There were no periventricular leukomalacia and neonatal death in all groups. CONCLUSION: Neonates delivered more than 7 days after first corticosteroid dose needed more short-term ventilatory support, but there were no differences in other neonatal outcomes.

The effect of multiple courses of antenatal corticosteroid therapy on perinatal outcome of the preterm neonates / 대한산부인과학회지

OBJECTIVE: To investigate the effect of multiple courses of antenatal corticosteroid (ACS) therapy on perinatal outcomes, especially the respiratory distress syndrome (RDS), of the premature neonates. METHODS: We retrospectively evaluated the pregnancy and neonatal outcomes of 622 singleton pregnancies delivered at 24-34 weeks of gestation from January 1996 to December 2005. Subjects were categorized into three groups according to ACS exposure: (1) a non-user group (n=234), (2) a single-course group (n=299) and (3) a repeated-course group (n=89). Univariate and multiple logistic regression analyses were used for the incidences of RDS. RESULTS: Pregnancy outcomes including gestational age at delivery, occurrence of clinical and histological chorioamnionitis, birth weight, neonatal intensive care unit (NICU) admission rate, duration of NICU stay and neonatal mortality were similar in the three groups. The incidence of RDS was significantly lower in ACS user groups than the non-user group, with lowest incidence in multiple-course group (44.9% vs. 37.8% vs. 12.4%, p<0.001). The incidence of bronchopulmonary dysplasia and overall neonatal composite morbidity were also lowest in multiple-course group. Multivariate analysis showed that multiple courses of ACS were associated with reduced incidence of RDS (OR 0.100, 95% CI 0.042, 0.240, p<0.001) independently with gestational age at delivery, admission-to-delivery interval and premature rupture of membranes. CONCLUSION: Multiple courses of ACS administered to women with risk of preterm delivery were found to be associated with decreased incidence of RDS of the premature neonates.

The effect of antenatal corticosteroid therapy on fetal growth / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to determine the effects of antenatal corticosteroid therapy on fetal growth. METHODS: We performed a retrospective analysis of 797 singleton-pregnant women with high risk of preterm delivery who admitted between 24 and 34 weeks' gestation. They were categorized into three groups; (1) no antenatal corticosteroid users (non-user group), (2) single course of corticosteroid users (single-course group), (3) multiple courses of corticosteroid users (multiple-course group). The birth weight, head circumference (HC), abdominal circumference (AC) and chest circumference (CC) of their neonates were measured. We surveyed if the neonates were small-for-gestational age (SGA) or not. RESULTS: According to antenatal corticosteroid use, 295 patients were included in the non-user group, 409 patients in the single-course group and 93 patients in the multiple-course group, respectively. The birth weight, HC, AC, CC and the rate of SGA of the neonates did not differ between any of the three groups. After adjusting the gestational age at delivery, the birth weight, HC, AC, CC and the rate of SGA of the neonates still showed no difference between any of the three groups. CONCLUSION: The antenatal corticosteroid administration to patients with risk of preterm delivery seems to have no effect on the birth weight and biometries of the neonates, and fetal growth does not seem to be associated with the number of courses of antenatal corticosteroid.

The effects of multiple courses of antenatal corticosteroid therapy on perinatal outcomes in premature neonates / 대한산부인과학회잡지

OBJECTIVE: The aims of this study are to determine the effects of multiple courses of antenatal corticosteroid therapy on the perinatal outcomes, especially the respiratory outcomes of the preterm neonates and to compare them with the single course of antenatal corticosteroid therapy. METHODS: We performed a retrospective analysis of 282 mothers who admitted between 24 and 34 weeks' gestation with high risk of preterm delivery and delivered before 34 weeks' gestation. They were categorized into three groups; (1) no antenatal corticosteroid user (non-user group), (2) single course of corticosteroid user (single-course group), (3) multiple courses of corticosteroid user (multiple-course group). Then we compared the pregnancy results and the perinatal outcomes, especially the respiratory outcomes of neonates in each groups. RESULTS: One hundred twenty-four patients were included in steroid non-user group, 111 patients in single- course group and 47 patients in multiple-course group respectively. There were no statistical differences of pregnancy results including the occurrence of clinical and histological chorioamnionitis, gestational age at delivery, birth weight, neonatal intensive care unit admission rate and hospital stay, ventilator treatment rate and neonatal death among the three groups. But the duration of ventilator treatment was significantly shorter in multiple-course group. The incidence of neonatal respiratory distress syndrome was significantly lower in multiple-course group, and the incidence tends to decrease as the number of corticosteroid use increases. Multiple logistic regression analysis and Spearman's partial correlation test revealed that multiple courses of antenatal corticosteroid treatment were significantly associated with lower incidence of neonatal respiratory distress syndrome and shorter duration of ventilator treatment respectively, even after the adjustment of other independent variables. There were no significant differences of other neonatal morbidities among the three groups. CONCLUSION: Multiple doses of antenatal corticosteroid administered to patients with risk of preterm delivery is associated with shorter duration of ventilator therapy and lower incidence of respiratory distress syndrome of the premature neonates without complicating any other perinatal outcomes.

The Effect of Antenatal Corticosteroid on Perinatal Outcomes of Preterm Births / 대한산부인과학회잡지

OBJECTIVES: To determine the effectiveness and clinical utility of antenatal corticosteroids in the reduction of neonatal morbidity and mortality on preterm birth Material and method: Neonatal outcomes of 312 preterm babies were evaluated retrospectively. One hundred and two preterm babies(study group) were given dexamethasone more than 1 dose antenatally and 210 preterm babies(control group) were not given dexamethasone antenatally. Antenatal steroids were administered in the form of four 5mg intramuscular doses of dexamethasone 12 hours apart. Maternal and neonatal outcomes of study group were compared with those of control group. Student t- test, x2 test, Fisher's exact test, and logistic regression analysis were used where appropriate. p-value< 0.05 was considered significant. RESULTS: Antentenatal corticosteroid significantly decreased the incidence of RDS(OR:0.47, 95% CI:0.25-0.86), IVH/PVL(OR : 0.32, 95% CI : 0.12-0.86), necrotizing enterocolitis(OR : 0.49, 95% CI : 0.25-0.98), and neonatal death(OR: 0.30, 95% CI: 0.10 - 0.89) in preterm delivery. In the presence of PROM, antenatal corticosteoid seemed to have no protective effect on the neonatal complications such as RDS, IVH/PVL, NEC, PDA, and neonatal death. CONCLUSIONS: Antenatal administration of corticosteroids was effective to decrease the incidence of neonatal morbidity and neonatal mortality in the preterm neonates with no apparent maternal complications.

Antenatal Corticosteroid Therapy to Prevent Neonatal Respiratory Distress Syndrome / 대한주산의학회잡지

OBJECTIVES: Our purpose was to determine the efficacy of maternal corticosteroid therapy in the prevention of neonatal respiratory distress syndrome. STUDY DESIGN: The data in this study was taken from 136 women who participated in prematurity prevention programs at two hospital. Of 136 women who were delivered at 25 to 34 weeks, 68 received dexamethasone and 68 did not. 'I'he frequency and relative risk of adverse outcomes, including repiratory distress syndrome, necrotizing enterocolitis, neonatal sepsis and maternal infection wcre compared by means of univariate techniques. RESULT: When dexamethansone was administered, there was a lower incidence of respiratory distress syndrome at between 30 to 32 weeks gestation (relative risk of treatment group vs control group=0.425, p0.05). I'here was no statistical difference between 33 weeks to 34 weeks (relative risk of treatment group vs control group=0.782, p>0.05). 'I'here was no statistical significance in the incidence of maternal infection, neonatal sepsis or necrotizing enterocolitis (p=0.808, p=0.698, p=0.559). CONCLUSION: Dexamethasone appears to significantly reduce neonatal respiratory distress syndrome at between 30 and 32 weeks gestation.