Administration of Antenatal Corticosteroids: Current State of Knowledge

Berger, Richard E.; Kyvernitakis, Ioannis; Maul, Holger

doi:10.1055/a-1555-3444

Cited by 4 publications

(3 citation statements)

References 70 publications

(204 reference statements)

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“…The administration of antenatal corticosteroids (ACS) in premature births delivered prior to gestational week (GW) 34 leads to a significant reduction in perinatal morbidity and mortality 1 2 . Their effectiveness depends crucially on optimal timing 3 .…”

Section: Introductionmentioning

confidence: 99%

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Administration of Antenatal Corticosteroids: Optimal Timing

Berger,

Stelzl,

Maul

2024

Geburtshilfe Frauenheilkd

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The effectiveness of antenatal corticosteroids (ACS) in significantly reducing respiratory distress syndrome (RDS) depends crucially on the timing. It is successful if delivery takes place between 24 hours and seven days following administration; after this period, the side effects seem to predominate. In addition, an increased rate of mental impairment and behavioral disorders are observed in children born full-term after ACS administration. The optimal timing of ACS administration depends crucially on the given indication; to date, it has been achieved in only 25–40% of cases. ACS administration is always indicated in PPROM, in severe early pre-eclampsia, in fetal IUGR with zero or reverse flow in the umbilical artery, in placenta previa with bleeding, and in patients experiencing premature labor with a cervical length < 15 mm. The risk of women with asymptomatic cervical insufficiency giving birth within seven days is very low. In this case, ACS should not be administered even if the patient’s cervical length is less than 15 mm, provided that the cervix is closed and there are no other risk factors for a premature birth. The development of further diagnostic methods with improved power to predict premature birth is urgently needed in order to optimize the timing of ACS administration in this patient population. Caution when administering ACS is also indicated in women experiencing premature labor who have a cervical length ≥ 15 mm. Further studies using amniocentesis are needed in order to identify the patient population with microbial invasion of the amniotic cavity/intra-amniotic infection (MIAC/IAI), and to define threshold values at which delivery is indicated. ACS administration is not performed as an emergency measure, usually not even before transfer to a perinatal center. Therefore, whenever possible, the indication for ACS administration should be determined by a clinician who is highly experienced in perinatology.

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Section: Introductionmentioning

confidence: 99%

“…Die Applikation antenataler Kortikosteroide (ACS) bei einer Frühgeburt vor 34 SSW führt zu einer signifikanten Senkung der perinatalen Morbidität und Mortalität 1 2 . Deren Effektivität hängt entscheidend von einem optimalen Timing ab 3 .…”

Section: Introductionunclassified

Administration of Antenatal Corticosteroids: Optimal Timing

Berger,

Stelzl,

Maul

2024

Geburtshilfe Frauenheilkd

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“…Für diesen Zeitraum gibt es kein einheitliches therapeutisches Vorgehen, stattdessen wird eine individuelle und risikoadaptierte Entscheidung über das Therapieziel ermöglicht. In der Grauzone scheinen fetomaternale RF die Überlebenschance eines FG entscheidend zu beeinflussen [4][5][6][7][8][9][10][11][12][13].…”

Section: Introductionunclassified

Einfluss von fetomaternalen Risikofaktoren auf die Mortalität und Morbidität von Extremfrühgeborenen

Winkler,

Cloppenburg,

Heep

et al. 2023

Z Geburtshilfe Neonatol

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Zusammenfassung Einleitung Die Behandlung von Schwangeren bei drohender Frühgeburt stellt eine interdisziplinäre Herausforderung dar. An der Grenze der Lebensfähigkeit spielen fetomaternale Risikofaktoren (RF) eine entscheidende Rolle in der individuellen Beratung und den Therapieansätzen. Methoden An einem Level-1-Perinatalzentrum (PNZ) wurden in einer retrospektiven Beobachtungsstudie zwischen 2017 und 2020 alle Frühgeborenen (FG) mit einem Gestationsalter (GA) zwischen 230/7 und 246/7 Schwangerschaftswochen (SSW) erfasst, die postnatal mit einem kurativen Therapieansatz behandelt wurden. Eingeteilt in zwei Gruppen (230/7 –236/7 und 240/7–246/7 SSW) wurden die FG unter Berücksichtigung der fetomaternalen RF hinsichtlich der Mortalität und Morbidität verglichen. Analysiert wurden 13 definierte RF und deren prognostische Relevanz für das Überleben. Ergebnisse Es wurden 41 Mütter mit 48 FG eingeschlossen. Ausgeschlossen wurden 9 FG, die primär palliativ behandelt wurden. Die Überlebensraten der Gruppen (n=21, n=27) zeigten keine signifikanten Unterschiede (66,7% versus 74,1%, p=0,750). Bei steigender Anzahl an RF wurde eine signifikant höhere Mortalität beobachtet (p=0,004), schwerwiegend waren hypertensive Schwangerschaftserkrankungen und ein vorzeitiger Blasensprung. Die Morbiditätsdaten zeigten keine signifikanten Unterschiede. Schlussfolgerung Die vorliegenden Daten bezüglich der Mortalität entsprachen den nationalen Daten. Die Morbidität dieser FG konnte erfasst werden. Durch die Berücksichtigung der RF lässt sich die Vorhersage der Überlebenswahrscheinlichkeit präzisieren.

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Current Concepts of Corticosteroids Use for the Prevention of Bronchopulmonary Dysplasia

Perrone

Orlando

Petrolini

et al. 2023

CPR

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Despite the use of antenatal steroids, surfactants and protective ventilation, bronchopulmonary dysplasia (BPD) affects 10-89% of preterm infants. Since lung inflammation is central to the BPD pathogenesis, postnatal systemic corticosteroids could reduce the risk of BPD onset in preterm infants, but short and long-term adverse consequences have been underlined in literature after their use (i.e. hyperglycaemia, hypertension, hypertrophic cardiomyopathy, growth failure, gastrointestinal bleeding, cerebral palsy). To avoid their adverse effects, alternative therapeutic strategies such as postponing corticosteroid administration, lowering the cumulative dose, giving pulse rather than continuous doses, or individualizing the dose according to the respiratory condition of the infant have been proposed. Dexamethasone nonetheless remains the first line drug for newborns with severe pulmonary disease beyond the second to third week of life. Hydrocortisone administration in very preterm infants does not appear to be associated with any neurotoxic effects, even if its efficacy in the prevention and treatment of BPD has yet to be clearly demonstrated. Alternative methods of corticosteroids administration seem promising. A positive effect on BPD prevention occurs when budesonide is nebulized and intratracheally instilled with surfactant, but more data are required to establish safety and efficacy in preterm newborns. Additional studies are still needed before the chronic lung disease issue and its related challenges can be solved.

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Administration of Antenatal Corticosteroids: Current State of Knowledge

Cited by 4 publications

References 70 publications

Administration of Antenatal Corticosteroids: Optimal Timing

Administration of Antenatal Corticosteroids: Optimal Timing

Einfluss von fetomaternalen Risikofaktoren auf die Mortalität und Morbidität von Extremfrühgeborenen

Current Concepts of Corticosteroids Use for the Prevention of Bronchopulmonary Dysplasia

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