Antenatal corticosteroid therapy: A meta-analysis of the randomized trials, 1972 to 1994

Crowley, Patricia

doi:10.1016/0002-9378(95)90222-8

Cited by 843 publications

(467 citation statements)

References 51 publications

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“…Antenatal glucocorticoid treatment is given to women at risk of preterm delivery because it decreases the risk of death, RDS, and intraventricular hemorrhage (25). Preterm rupture of the membranes and histological chorioamnionitis are not contraindications to maternal glucocorticoids (26,27), and women with undiagnosed chorioamnionitis with preterm labor currently receive corticosteroids to enhance fetal lung maturation (26,27).…”

Section: Sga and Respiratory Morbiditymentioning

confidence: 99%

Respiratory morbidity at follow-up of small-for-gestational-age infants born very prematurely

Peacock

D'Costa

et al. 2012

Pediatr Res

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Background:The aim of this study was to determine whether small-for-gestational-age (sGA) infants born very prematurely had increased respiratory morbidity in the neonatal period and at follow-up. Methods: Data were examined from infants recruited into the United Kingdom Oscillation study (UKOs). Of the 797 infants who were born at <29 wk of gestational age, 174 infants were sGA. Overall, 92% were exposed to antenatal corticosteroids and 97% received surfactant; follow-up data at 22-28 mo were available for 367 infants. results: After adjustment for gestational age and sex, sGA infants had higher rates of supplementary oxygen dependency at 36 wk postmenstrual age (odds ratio (OR): 3.23; 95% confidence interval: 2.03, 5.13), pulmonary hemorrhage (OR: 3.07; 95% cI: 1.82, 5.18), death (OR: 3.32; 95% cI: 2.13, 5.17), and postnatal corticosteroid requirement (OR: 2.09; 95% cI: 1.35, 3.23). After adjustment for infant and respiratory morbidity risk factors, a lower mean birth weight z-score was associated with a higher prevalence of respiratory admissions (OR: 1.40; 95% cI: 1.03, 1.88 for 1 sD change in z-score), cough (OR: 1.28; 95% cI: 1.00, 1.65), and use of chest medicines (OR: 1.32; 95% cI: 1.01, 1.73). conclusion: sGA infants who were born very prematurely, despite routine use of antenatal corticosteroids and postnatal surfactant, had increased respiratory morbidity at follow-up, which was not due to poor neonatal outcome.

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Section: Sga and Respiratory Morbiditymentioning

confidence: 99%

Respiratory morbidity at follow-up of small-for-gestational-age infants born very prematurely

Peacock

D'Costa

et al. 2012

Pediatr Res

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“…With the increasing use of prenatal steroids, the incidence as well as the severity of RDS has decreased by nearly 50% over the last few years. 3,4 Respiratory distress syndrome occurs in approximately 50% of preterm infants born at <30 weeks gestation, but only in about 25% of those born X30 weeks. Surfactant therapy has been shown to reduce the combined outcomes of death and bronchopulmonary dysplasia (BPD) in preterm infants with RDS.…”

Section: Introductionmentioning

confidence: 99%

Surfactant therapy in preterm infants with respiratory distress syndrome and in near-term or term newborns with acute RDS

Ramanathan

2006

J Perinatol

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Many different surfactant preparations derived from animal sources, as well as synthetic surfactants, are available for the treatment of preterm infants with respiratory distress syndrome (RDS). Natural, modified surfactants containing surfactant-associated proteins appear to be more effective than non-protein-containing synthetic surfactants. Comparative trials with poractant alfa at a higher initial dose of 200 mg/kg appear to be associated with rapid weaning of FiO 2 , less need for additional doses, and decreased mortality in infants <32 weeks gestation when compared with beractant. Early rescue (<30 min of age) surfactant therapy is an effective method to minimize over treatment of some preterm infants who may not develop RDS. Surfactant therapy followed by rapid extubation to nasal ventilation appears to be more beneficial than continued mechanical ventilation. In near-term or term newborns with acute RDS, surfactant therapy has been shown to be 70% effective in improving respiratory failure.

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“…[20][21][22][23][24][25][26][27] The acceleration of lung development leads to a reduction in the incidence of respiratory distress syndrome and its severity. 17,[28][29][30] The structural and biochemical alterations induced by corticosteroids translate into a diminution of the need for and duration of mechanical ventilation for newborns with respiratory insufficiency. [31][32][33] In developed countries, a significant reduction has also been observed in deaths from respiratory diseases through the widespread use of antenatal corticosteroids.…”

Section: Introductionmentioning

confidence: 99%

“…34 This antenatal therapy should be considered not only because of the pulmonary maturation, but also for its protective role in the premature infant's brain. The use of antenatal corticosteroids leads to substantial reduction in the incidence of periintraventricular hemorrhage 17,[28][29][30] and its severe forms 35 that produce important neurological sequelae among the survivors. 36 In addition to this, the cardiovascular stabilization promoted by corticosteroids and the modifications in renal function are essential for the extra-uterine survival of extremely premature infants.…”

Section: Introductionmentioning

confidence: 99%

Antenatal treatment with corticosteroids for preterm neonates: impact on the incidence of respiratory distress syndrome and intra-hospital mortality

et al. 2003

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CONTEXT: Although the benefits of antenatalcorticosteroids 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% 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% 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% 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% 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.

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Antenatal corticosteroid therapy: A meta-analysis of the randomized trials, 1972 to 1994

Cited by 843 publications

References 51 publications

Respiratory morbidity at follow-up of small-for-gestational-age infants born very prematurely

Respiratory morbidity at follow-up of small-for-gestational-age infants born very prematurely

Surfactant therapy in preterm infants with respiratory distress syndrome and in near-term or term newborns with acute RDS

Antenatal treatment with corticosteroids for preterm neonates: impact on the incidence of respiratory distress syndrome and intra-hospital mortality

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