Antenatal corticosteroids beyond 34 weeks gestation: What do we do now?

Kamath‐Rayne, Beena D.; Rozance, Paul J.; Goldenberg, Robert L.; Jobe, Alan H.

doi:10.1016/j.ajog.2016.06.023

Cited by 80 publications

(50 citation statements)

References 46 publications

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“…Maternal hyperglycemia will cause hypoglycemia in newborns, which increased from 15% to 24% in a trial of ACS for late preterm pregnancies . In low resource environments, newborn hypoglycemia may not be effectively monitored or treated, and may cause neurodevelopmental injury …”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics and Pharmacodynamics of Intramuscular and Oral Betamethasone and Dexamethasone in Reproductive Age Women in India

Jobe

Milad²,

Peppard

et al. 2019

Clinical Translational Sci

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High‐dose betamethasone and dexamethasone are standard of care treatments for women at risk of preterm delivery to improve neonatal respiratory and mortality outcomes. The dose in current use has never been evaluated to minimize exposures while assuring efficacy. We report the pharmacokinetics and pharmacodynamics (PDs) of oral and intramuscular treatments with single 6 mg doses of dexamethasone phosphate, betamethasone phosphate, or a 1:1 mixture of betamethasone phosphate and betamethasone acetate in reproductive age South Asian women. Intramuscular or oral betamethasone has a terminal half‐life of 11 hours, about twice as long as the 5.5 hours for oral and intramuscular dexamethasone. The 1:1 mixture of betamethasone phosphate and betamethasone acetate shows an immediate release of betamethasone followed by a slow release where plasma betamethasone can be measured out to 14 days after the single dose administration, likely from a depo formed at the injection site by the acetate. PD responses were: increased glucose, suppressed cortisol, increased neutrophils, and suppressed basophils, CD3CD4 and CD3CD8 lymphocytes. PD responses were comparable for betamethasone and dexamethasone, but with longer times to return to baseline for betamethasone. The 1:1 mixture of betamethasone phosphate and betamethasone acetate caused much longer adrenal suppression because of the slow release. These results will guide the development of better treatment strategies to minimize fetal and maternal drug exposures for women at risk of preterm delivery.

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Section: Discussionmentioning

confidence: 99%

Pharmacokinetics and Pharmacodynamics of Intramuscular and Oral Betamethasone and Dexamethasone in Reproductive Age Women in India

Jobe

Milad²,

Peppard

et al. 2019

Clinical Translational Sci

Self Cite

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“…All these aspects have been discussed in recent reviews; therefore, the issue remains controversial [59, 60]. It is in this context that the selection of a low-risk group for respiratory morbidity by a non-invasive tool might reduce exposure in a large number of pregnancies, avoiding the risks of overexposure in an unselected population and optimizing intervention in those cases for which it is needed.…”

Section: Commentmentioning

confidence: 99%

Prediction of neonatal respiratory morbidity by quantitative ultrasound lung texture analysis: a multicenter study

Palacio¹,

Bonet‐Carne²,

Cobo³

et al. 2017

American Journal of Obstetrics and Gynecology

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Background Prediction of neonatal respiratory morbidity may be useful to plan delivery in complicated pregnancies. The limited predictive performance of the current diagnostic tests together with the risks of an invasive procedure restricts the use of fetal lung maturity assessment. Objective The objective of this study was to evaluate the performance of quantitative ultrasound texture analysis of the fetal lung (quantusFLM) to predict neonatal respiratory morbidity in preterm and early-term (<39.0 weeks) deliveries. Study Design This was a prospective multicenter study conducted in 20 centers worldwide. Fetal lung ultrasound images were obtained at 25.0-38.6 weeks of gestation within 48 hours of delivery, stored in Digital Imaging and Communication in Medicine format, and analyzed with quantusFLM. Physicians were blinded to the analysis. At delivery, perinatal outcomes and the occurrence of neonatal respiratory morbidity, defined as either respiratory distress syndrome or transient tachypnea of the newborn, were registered. The performance of the ultrasound texture analysis test to predict neonatal respiratory morbidity was evaluated. Results A total of 883 images were collected, but 17.3% were discarded because of poor image quality or exclusion criteria, leaving 730 observations for the final analysis. The prevalence of neonatal respiratory morbidity was 13.8% (101/730). The quantusFLM predicted neonatal respiratory morbidity with a sensitivity, specificity, and positive and negative predictive values of 74.3% (75/101), 88.6% (557/629), 51.0% (75/147), and 95.5% (557/583), respectively. Accuracy was 86.5% (632/730), and the positive and negative likelihood ratios were 6.5 and 0.3, respectively. Conclusion The quantusFLM predicted neonatal respiratory morbidity with an accuracy similar to that previously reported for other tests with the advantage of being a non-invasive technique.

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“…In pregnancies between 34 and 36 weeks’ gestation, prenatal steroids also reduce risk of short-term respiratory morbidity but not mortality, and there is increased risk of neonatal hypoglycaemia [23]. Long-term follow-up data are broadly reassuring, albeit sketchy [24], and given the potential for long-term side-effects, steroids are not currently recommended for women in spontaneous preterm labour after 34 weeks [25]. When given before elective Caesarean section (CS) up to 39 weeks, they reduce risk of admission to NICU, although the number needed to treat is >20 and follow-up data on term babies exposed to antenatal steroids are lacking [26].…”

Section: Prenatal Carementioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Antenatal corticosteroids beyond 34 weeks gestation: What do we do now?

Cited by 80 publications

References 46 publications

Pharmacokinetics and Pharmacodynamics of Intramuscular and Oral Betamethasone and Dexamethasone in Reproductive Age Women in India

Pharmacokinetics and Pharmacodynamics of Intramuscular and Oral Betamethasone and Dexamethasone in Reproductive Age Women in India

Prediction of neonatal respiratory morbidity by quantitative ultrasound lung texture analysis: a multicenter study

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

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