Antenatal treatment with corticosteroids for preterm neonates: impact on the incidence of respiratory distress syndrome and intra-hospital mortality
São Paulo med. j
; 121(2): 45-52, Mar. 3, 2003. tab
Article
in English
| LILACS
| ID: lil-342141
Responsible library:
BR1.1
RESUMO
CONTEXT Although the benefits of antenatal corticosteroids have been widely demonstrated in other countries, there are few studies among Brazilian newborn infants. OBJECTIVE:
To evaluate the effectiveness of antenatal corticosteroids on the incidence of respiratory distress syndrome and intra-hospital mortality among neonates with a gestational age of less than 34 weeks. TYPE OF STUDY Cross-sectional.SETTING:
A tertiary-care hospital.PARTICIPANTS:
Neonates exposed to any dose of antenatal corticosteroids for fetal maturation up to 7 days before delivery, and newborns paired by sex, birth weight, gestational age and time of birth that were not exposed to antenatal corticosteroids. The sample obtained consisted of 205 exposed newborns, 205 non-exposed and 39 newborns exposed to antenatal corticosteroids for whom it was not possible to find an unexposed pair. PROCEDURES Analysis of maternal and newborn records. MAIN MEASUREMENTS The primary clinical outcomes for the two groups were compared the incidence of respiratory distress syndrome and intra-hospital mortality; as well as secondary outcomes related to neonatal morbidity.RESULTS:
Antenatal corticosteroids reduced the occurrence of respiratory distress syndrome (OR 0.33; 95 percent CI 0.21-0.51) and the protective effect persisted when adjusted for weight, gestational age and the presence of asphyxia (adjusted OR 0.27; 95 percent CI 0.17-0.43). The protective effect could also be detected through the reduction in the need for and number of doses of exogenous surfactant utilized and the number of days of mechanical ventilation needed for the newborns exposed to antenatal corticosteroids. Their use also reduced the occurrence of intra-hospital deaths (OR 0.51 95 percent CI 0.38-0.82). However, when adjusted for weight, gestational age, presence of prenatal asphyxia, respiratory distress syndrome, necrotizing enterocolitis and use of mechanical ventilation, the antenatal corticosteroids did not maintain the protective effect in relation to death. With regard to other outcomes, antenatal corticosteroids reduced the incidence of intraventricular hemorrhage grades III and IV (OR 0.28; 95 percent CI 0.10-0.77).CONCLUSIONS:
Antenatal corticosteroids were effective in the reduction of morbidity and mortality among premature newborns in the population studied, and therefore their use should be stimulated within our environment
Full text:
Available
Collection:
International databases
Health context:
SDG3 - Health and Well-Being
/
SDG3 - Target 3.1 Reduce Maternal Mortality
/
SDG3 - Target 3.4 Reduce premature mortality due to noncommunicable diseases
Health problem:
Target 3.1: Reduce maternal mortality
/
Maternal Care
/
Other Respiratory Diseases
Database:
LILACS
Main subject:
Prenatal Care
/
Respiratory Distress Syndrome, Newborn
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Infant, Premature
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Hospital Mortality
/
Adrenal Cortex Hormones
Type of study:
Incidence study
/
Observational study
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Prognostic study
/
Risk factors
Limits:
Adult
/
Female
/
Humans
/
Infant
/
Male
/
Infant, Newborn
/
Pregnancy
Country/Region as subject:
South America
/
Brazil
Language:
English
Journal:
São Paulo med. j
Journal subject:
Cirurgia Geral
/
Cincia
/
Ginecologia
/
Medicine
/
Medicina Interna
/
Obstetr¡cia
/
Pediatria
/
Sa£de Mental
/
Sa£de P£blica
Year:
2003
Document type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
Universidade Federal de São Paulo/BR