Antenatal Thyrotropin-Releasing Hormone to Prevent Lung Disease in Preterm Infants

Abstract

In preterm infants at risk for lung disease, antenatal administration of thyrotropin-releasing hormone and glucocorticoid is no more beneficial than glucocorticoid alone.

Use of inhaled nitric oxide in the preterm infant

“…These positive findings were reported at the same time as the multicenter study by Van Meurs et al [14], which enrolled 420 infants with severe respiratory failure (mean oxygenation index of [22][23]. Infants were randomized at 26-28 h of life to receive placebo gas or INO at 5 ppm, which could be increased to 10 ppm if inadequate improvement in oxygenation was seen.…”

“…Even though nearly 2500 babies have been enrolled in randomized clinical trials (Table 1), there remains uncertainty regarding its role in the neonatal ICU [22]. Potential reasons are that findings from preclinical trials may not apply to infants (for example, thyrotropin-releasing hormone [23]), that unknown harms may be discovered (for example, dexamethasone [24]), or that the designs of the studies are so different that metaanalysis [25 ] is difficult and definitive interpretation is limited.…”

Avoiding the prenatal programming effects of glucocorticoids: are there alternative treatments for the induction of antenatal lung maturation?

“…We were not able to identify RCTs on TRH for lung maturation dating after 2009. Large Australian [2] and American [10] studies as well as a Cochrane meta-analysis [35] have been unable to find enhancement for neonatal short-and longterm adverse effects [34,53] .…”

“…Ballard et al examined the effect of TRH treatment on pituitary-thyroid function of extreme preterm neonates and found that extremely premature infants had a reduced postnatal increase in TSH and T3 as well as maintained lower T3 concentrations, probably reflecting tertiary hypothyroidism [12] . However, the activating and suppressive effects of antenatal TRH treatment have been reported to be temporary, with no effect on pituitary-thyroid responsiveness at 28 days of age [10] . The ACTOBAT-1995 [2] meta-analysis examined the effect of 200 ug/d TRH in addition to GC, and the authors demonstrated that TRH-treated newborns had lower Apgar scores, required more antibiotics, and suffered more often from RDS [relative risk (RR) = 1.25] than the control group with only GC treatment.…”

A comparison of the effectiveness of single-dose vs multi-dose antenatal corticosteroids in pre-term neonates

“…Decreased fetal growth continues to be an important consideration in the use of multiple AC. Growth restriction has been shown to occur in lambs and other rapidly growing short-gestation species exposed to AC (Ballard et al 1998;Stewart et al 1997;Sun et al 1993). The data on human fetal growth is conflicting with some studies suggesting a trend to impaired growth.…”