Antenatal Glucocorticoid Treatment and Cystic Periventricular Leukomalacia in Very Premature Infants

Baud, Olivier; Foix‐L’Hélias, L.; Kaminski, Monique; Audibert, François; Jarreau, Pierre‐Henri; Papiernik, E; Huon, Catherine; Lepercq, J.; Dehan, M; Lacaze‐Masmonteil, Thierry

doi:10.1097/00006254-200003000-00009

Cited by 112 publications

(154 citation statements)

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“…Taken together, our ventilatory data suggest that betamethasone might be increasing lung compliance more effectively compared to dexamethasone, similar to benefits seen when comparing antenatal use. 16 The percentage of neonates extubated to continuous positive airway pressure, number of ventilation days and length of hospital stay were comparable between the two groups. Likewise, the number of days in oxygen, ventilator days, length of hospital stay and the incidence of BPD were similar in the two treatment groups, as we would predict.…”

Section: Characteristics Of Patientsmentioning

confidence: 84%

“…However, it is already known that betamethasone is less permeable to the blood-brain barrier than dexamethasone and accordingly, prenatal betamethasone is associated with less risk of cystic periventricular leukomalacia, better neurodevelopmental outcome and reduced risk of hearing impairment compared to prenatal dexamethasone. 16,35 Moreover, animal and cell culture experiments show that low-dose glucocorticoid is neuroprotective whereas high-dose is neurodegenerative. 15,36,37 In a similar but randomized trial using a low-dose dexamethasone protocol (0.15 mg kg À1 per day starting dose with a 10-day tapering course; total exposure: 0.88 mg kg À1 ), 35 ELBW neonates received glucocorticoid and 35 patients received placebo.…”

Section: Postnatal Betamethasone Vs Dexamethasone M Decastro Et Almentioning

confidence: 99%

“…First, antenatal betamethasone has been associated with a decreased risk of cystic periventricular leukomalacia (PVL) when compared to dexamethasone or the absence of glucocorticoid therapy. 16 Second, the penetration of dexamethasone into the central nervous system is higher compared to betamethasone because of higher lipid solubility and lower binding to serum proteins of dexamethasone compared to betamethasone. 17 Third, a single subcutaneous dose of 0.1 mg of betamethasone is 2-to 3-fold more potent than dexamethasone in accelerating fetal lung maturity without impairing fetal survival or weight gain.…”

Section: Introductionmentioning

confidence: 99%

“…18,19 Fourth, betamethasone has been used in pregnancy for over 20 years with an unprecedented high level of safety and efficacy. 16 Fifth, importantly, recent studies in sheep and human infants have shown that intravenous betamethasone reduces cerebral blood flow, suggesting its vasoconstrictor effect. 20,21 Thus, betamethasone might affect the incidence of intraventricular hemorrhage and PVL in extremely premature infants.…”

Section: Introductionmentioning

confidence: 99%

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Postnatal betamethasone vs dexamethasone in premature infants with bronchopulmonary dysplasia: a pilot study

et al. 2008

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Objective: As effects of glucocorticoids differ with respect to preparation, dose and duration, we hypothesized that a postnatal regimen of a low-dose, short-course betamethasone treatment had comparable efficacy and a better safety profile compared to the conventional high-dose, dexamethasone.Study Design: To test our hypothesis, we selected premature neonates with a birth weightp1000 g and a gestational age p29 weeks who were ventilated >10 postnatal days with an FiO 2 >0.4 and no ability to wean mechanical support for X3 consecutive days. These neonates either received twice daily dexamethasone 0.25 mg kg À1 per dose intravenously for 3 days tapered to 0.125 mg kg À1 per dose for 4 days (June 1999 to December 2000) or betamethasone 0.125 mg kg À1 per day intramuscularly once per day for 3 days (January 2001 to December 2002). Result:We found a significant reduction in FiO 2 after 3 days in both glucocorticoid treatment groups. There were no significant differences between the two treatment groups in the clinical parameters including decrease in FiO 2 , oxygenation index, mean airway pressure and percent extubation. Duration of ventilation, number of oxygen days and length of hospital stay were comparable in the two groups. Of particular interest, the betamethasone group showed fewer adverse effects, such as poor weight gain and high blood glucose, than the dexamethasone group.Conclusion: A short course of low-dose betamethasone has comparable efficacy and seemingly a better short-term safety profile compared to conventional dexamethasone treatment.

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Section: Characteristics Of Patientsmentioning

confidence: 84%

Section: Postnatal Betamethasone Vs Dexamethasone M Decastro Et Almentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Postnatal betamethasone vs dexamethasone in premature infants with bronchopulmonary dysplasia: a pilot study

et al. 2008

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“…However, there remain questions about the optimal corticosteroid, the dose and the formulation, as reviewed in the new meta-analysis of corticosteroids (1). The betamethasone preparation used clinically is a 1 to 1 mixture of soluble and rapid acting betamethasonesodium-phosphate (Beta-PO 4 ) and the slow release betamethasone-acetate (Beta-Ac) originally selected by Liggins and Howie (2). The Beta-PO 4 and Beta-Ac mixture is the primary corticosteroid preparation used world-wide because its use is associated with better neonatal outcomes than dexamethasone (3,4).…”

Section: Introductionmentioning

confidence: 99%

Betamethasone for lung maturation: testing dose and formulation in fetal sheep

Jobe

Moss

Nitsos

et al. 2007

American Journal of Obstetrics and Gynecology

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Objectives-We evaluated lung maturation responses to the mixture of betamethasone phosphate (Beta-PO 4 ) + betamethasone acetate (Beta-Ac) in comparison to Beta-PO 4 or Beta-Ac in fetal sheep.Study Design-Ewes carrying singleton pregnancies at 122d gestation were randomized to: single doses of 0.5 mg/kg Beta-PO 4 + Beta-Ac, 0.25 mg/kg Beta-PO 4 , 0.5 mg/kg Beta-PO 4 or 0.25 mg/kg Beta-Ac given 48h before delivery. These treatments were compared to saline placebo and 2 doses of 0.5 mg/kg Beta-PO 4 + Beta-Ac given 48 and 24h prior to delivery. Fetal lung maturation was evaluated.Results-The 2 doses of the Beta-PO 4 + Beta-Ac mixture gave the best lung maturation. Single doses of the Beta-PO 4 + Beta-Ac mixture and Beta-Ac also induced lung maturation. There were no consistent responses to either dose of Beta-PO 4 .Conclusions-Beta-PO 4 alone is ineffective with the dosing schedule used, while Beta-Ac can induce lung maturation. However, the best responses result from the mixture of Beta-PO 4 + BetaAc.

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Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth

Brownfoot

Gagliardi

Bain

et al. 2013

Cochrane Database of Systematic Reviews

202

174

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It remains unclear whether one corticosteroid (or one particular regimen) has advantages over another.Dexamethasone may have some benefits compared with betamethasone such as less IVH, and a shorter length of stay in the NICU. The intramuscular route may have advantages over the oral route for dexamethasone, as identified in one small trial. Apart from the suggestion that 12-hour dosing may be as effective as 24-hour dosing of betamethasone based on one small trial, few other conclusions about optimal antenatal corticosteroid regimens were able to be made. No long-term results were available except for a small subgroup of 18 month old children in one trial. Trials comparing the commonly used corticosteroids are most urgently needed, as are trials of dosages and other variations in treatment regimens.

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Antenatal Glucocorticoid Treatment and Cystic Periventricular Leukomalacia in Very Premature Infants

Cited by 112 publications

References 0 publications

Postnatal betamethasone vs dexamethasone in premature infants with bronchopulmonary dysplasia: a pilot study

Postnatal betamethasone vs dexamethasone in premature infants with bronchopulmonary dysplasia: a pilot study

Betamethasone for lung maturation: testing dose and formulation in fetal sheep

Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth

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