Antenatal Corticosteroids—Too Much of a Good Thing?

Lawson, Edward E.

doi:10.1001/jama.286.13.1628

Cited by 19 publications

(8 citation statements)

References 23 publications

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“…However, glucocorticoids are potent regulators of growth and development [43]. While a single course of antenatal glucocorticoid treatment is beneficial for lung maturation and reduces complications such as neonatal respiratory distress syndrome [44], concerns have increased as to whether multiple doses have a greater influence on foetal development and later risk of adverse health [45].…”

Section: Antenatal Glucocorticoidsmentioning

confidence: 99%

Preeclampsia, prematurity and cardiovascular health in adult life

Lewandowski

Leeson

2014

Early Human Development

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Section: Antenatal Glucocorticoidsmentioning

confidence: 99%

Preeclampsia, prematurity and cardiovascular health in adult life

Lewandowski

Leeson

2014

Early Human Development

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“…A prospective observational study of preterm delivery comprising 766 neonates with birthweight less than 1000 g concluded that there was no apparent benefit (168). In women at the highest risk of respiratory distress, that is those for whom delivery continues to be a threat before 28 weeks' gestation, a repeated treatment may therefore be considered (169).…”

Section: Corticosteroidsmentioning

confidence: 99%

Preterm delivery: an overview

Haram¹,

Mortensen²,

Wollen³

2003

Acta Obstet Gynecol Scand

121

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Preterm delivery is the leading factor causing neonatal mortality and morbidity. We have conducted a PubMed literature search to obtain an update on the etiology, diagnostic problems and therapeutic considerations of preterm delivery. Approximately 5-10% of all births are premature. Preterm labor is associated with preterm rupture of membranes, cervical incompetence, polyhydramnion, fetal and uterine anomalies, infections, social factors, stress, smoking, heavy work and other risk factors. The diagnosis is made on the patients presenting symptoms, clinical findings and of progressive effacement and dilatation of the cervix. Biochemical markers of preterm delivery are of minor importance in daily clinical work. Measurement of the cervix, however, is a practical and valuable tool to predict preterm delivery. Cervical cerclage can be useful in selected cases. Antibiotics may help to prevent preterm labor in cases of known etiologic agents (e.g. preterm rupture of membranes and urinary infection). The use of tocolytic agents such as beta-sympathetic receptor stimulators can be advocated for a few days. There is evidence that their long-term use is not beneficial and could even be harmful to the fetus. Calcium channel blockers (nifedipine) and a new selective oxytocin receptor antagonist, atosiban, appear to be as effective as beta-sympathomimetic drugs on uterine contractions with fewer side-effects. Prostaglandin synthetase inhibitors such as indomethacin may prevent uterine contractions and can be used prior to the 32nd week of pregnancy. A single course of corticosteroid treatment in two doses of 12 mg betamethasone or 6 mg of dexamethasone is important for the prevention of respiratory distress between the 24th and 34th weeks of pregnancy. Multiple doses may be harmful and should be avoided. In these cases management should depend on gestation age (fetal maturity). Uterine contractions after 34 weeks' gestation are not an indication for tocolytic treatment.

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“…Por último, y realmente notable es la información del reporte clínico anual del 2005 del informe del Nacional Women´s Hospital en Auckland Nueva Zelanda donde se comunica que el 94% de los RN menores de 32 semanas de gestación recibió corticoides antenatales, y un 88% en el periodo 1995-2003 (14). En nuestro estudio, en el grupo que recibió corticoides, el 72% recibió las 2 dosis de betametasona y sólo un 7% una dosis de refuerzo, lo que demuestra cautela al momento de indicar más de 2 dosis de corticoides antenatales (15).…”

Section: Tabla IX Comparación De Los Resultados De Los Rnebpn Hospitunclassified

Pronóstico Neonatal Del Recién Nacido De Muy Bajo Peso: Hospital Regional De Puerto Montt, 2000-2005

M¹,

H²,

F³

et al. 2007

Rev. chil. obstet. ginecol.

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RESUMENObjetivos: Describir patologías obstétricas asociadas, manejo perinatal y pronóstico neonatal del recién nacido de muy bajo peso al nacer (RNMBPN). Método: Estudio transversal efectuado en el Hospital de Puerto Montt, Chile, en 347 RNMBPN, en el periodo 2000 -2005. Resultados: La incidencia de RNMBPN fue de 1,59 %. El 70% de las pacientes recibió corticoides prenatales. La principal causa de interrupción fue el síndrome hipertensivo del embarazo. El 68,5% de los partos fueron por cesárea. El 23,7% y 9,3% presentó depresión neonatal severa al minuto y cinco minutos de vida, respectivamente. La cesárea se asoció a una reducción significativa del riesgo de depresión neonatal severa y muerte neonatal. Las principales complicaciones neonatales fueron el síndrome de dificultad respiratoria (61,5%) y sepsis neonatal (24,7%). El 29,7% de los recién nacidos fallece. Las causas de muerte son la prematurez (44,7%), las infecciones (30,1%) y las malformaciones congénitas (14,6%). Conclusiones: En nuestro centro el manejo los RNMBPN presentó un aumento significativo del uso de corticoides antenatales, de surfactante y asistencia ventilatoria con CPAP nasal. Hubo una reducción significativa de la depresión neonatal severa a los 5 minutos de vida. La sobrevida neonatal presentó un aumento significativo en el cuartil de 500 a 749 gramos. La cesárea se asocia a una disminución significativa de la depresión neonatal severa y muerte neonatal.

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Antenatal Corticosteroids—Too Much of a Good Thing?

Cited by 19 publications

References 23 publications

Preeclampsia, prematurity and cardiovascular health in adult life

Preeclampsia, prematurity and cardiovascular health in adult life

Preterm delivery: an overview

Pronóstico Neonatal Del Recién Nacido De Muy Bajo Peso: Hospital Regional De Puerto Montt, 2000-2005

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