Efficacy of a single dose of antenatal steroid in surfactant-treated babies under 31 weeks' gestation

Sen, Siddhartha; Reghu, A.; Ferguson, S. D.

doi:10.1080/jmf.12.5.298.303

Cited by 23 publications

(10 citation statements)

References 14 publications

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“…As ~13 million babies are born premature worldwide every year, a huge number of preterm infants (about 5–6 millions) are exposed to prenatal steroid. This increases their survival and reduces both the incidence and severity of IVH 5,6. Yet, the molecular mechanism by which GCs prevent IVH is elusive.…”

Section: Introductionmentioning

confidence: 99%

Effect of Prenatal Glucocorticoids on Cerebral Vasculature of the Developing Brain

Vinukonda

Dummula

Malik

et al. 2010

Stroke

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Background and Purpose-Prenatal glucocorticoids prevent germinal matrix hemorrhage in premature infants. The underlying mechanism, however, is elusive. Germinal matrix is enriched with angiogenic vessels exhibiting paucity of pericytes and glial fibrillary acidic protein-positive astrocyte end feet. Therefore, we asked whether glucocorticoid treatment would suppress angiogenesis and enhance periendothelial coverage by pericytes and glial fibrillary acidic protein-positive end feet in the germinal matrix microvasculature. Methods-We treated pregnant rabbits with intramuscular betamethasone and delivered pups prematurely by cesarean section at E29 (termϭ32 days). Endothelial turnover, vascular density, pericyte coverage, glial fibrillary acidic protein-positive end feet, cell death, and growth factors orchestrating angiogenesis, including vascular endothelial growth factor, angiopoietins, transforming growth factor-␤, and platelet-derived growth factor-B, were compared between betamethasone-treated and untreated pups. Similar comparisons were done between autopsy materials from premature infants exposed and unexposed to prenatal glucocorticoids. Results-Antenatal glucocorticoid treatment reduced endothelial proliferation, vascular density, and vascular endothelial growth factor expression in the germinal matrix of both rabbits and humans. The pericyte coverage was greater in glucocorticoid-treated rabbit pups and human infants than in controls, but not the glial fibrillary acidic protein-positive end feet coverage. Transforming growth factor-␤, but not angiopoietins and platelet-derived growth factor-B, were elevated in glucocorticoid-treated rabbit pups compared with controls. Betamethasone treatment induced apoptosis, neuronal degeneration, and gliosis in rabbit pups. However, there was no evidence of increased cell death in glucocorticoid-exposed human infants. Conclusions-Prenatal glucocorticoid suppresses vascular endothelial growth factor and elevates transforming growth factor-␤ levels, which results in angiogenic inhibition, trimming of neovasculature, and enhanced pericyte coverage. These changes contribute to stabilizing the germinal matrix vasculature, thereby reducing its propensity to hemorrhage. Prenatal glucocorticoid exposure does not induce neural cell death in humans, unlike rabbits. (Stroke. 2010;41:1766-1773.)

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Section: Introductionmentioning

confidence: 99%

Effect of Prenatal Glucocorticoids on Cerebral Vasculature of the Developing Brain

Vinukonda

Dummula

Malik

et al. 2010

Stroke

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“…Studies comparing half course of CCS with no CCS therapy ( 18 – 20 ), showed that the exposure to an incomplete course of prophylaxis decreases the rate of severe neonatal outcomes, especially at very early gestational weeks (25–27 weeks) and in non-tertiary hospitals ( 18 ). Other observational studies compared the administration of an incomplete CCS course vs. a complete CCS course ( 21 – 24 ) demonstrating a significant improvement of the neonatal clinical outcome with the half dose exposure. However, a discrepancy between the studies is seen for severe IVH since a significantly lower rate of severe IVH was observed in the incomplete antenatal steroids group in the oldest study ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

“…Other observational studies compared the administration of an incomplete CCS course vs. a complete CCS course ( 21 – 24 ) demonstrating a significant improvement of the neonatal clinical outcome with the half dose exposure. However, a discrepancy between the studies is seen for severe IVH since a significantly lower rate of severe IVH was observed in the incomplete antenatal steroids group in the oldest study ( 21 ). At the same time, this trend was not confirmed in the most recent studies ( 23 , 24 ).…”

Section: Discussionmentioning

confidence: 99%

Partial vs. complete course of antenatal corticosteroid prophylaxis: An Italian single center retrospective study

Xodo

Trombetta²,

Celante³

et al. 2022

Front. Pediatr.

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IntroductionThis study aimed to compare the outcomes of preterm infants given 12 vs. 24mg of betamethasone prophylaxis to understand whether a partial course of antenatal corticosteroids (CCS) could prevent or mitigate the major preterm birth complications.MethodsThis is a retrospective single-center cohort study including neonates born between 24 and 34 weeks of gestation from 2001 to 2019 at the University Hospital of Udine. The study population was divided into two groups: one group received 12mg, and another received a 24mg dose of betamethasone before the delivery. A separate analysis was performed for single and multiple pregnancies. The two groups were evaluated for various neonatal outcomes.ResultsThe study population included a total of 1,258 pregnancies and 1,543 neonates delivered between 24 and 34 weeks of gestation, of which 1,022 (803 single and 219 multiple pregnancies) were exposed to the complete CCS prophylaxis, whereas 236 (192 single and 44 multiple pregnancies) received the incomplete CCS prophylaxis. In single pregnancies, as for maternal characteristics, the most significant differences observed between the two groups are the following: a higher prevalence of spontaneous vaginal deliveries in the incomplete CCS prophylaxis (36.46 vs. 23.91%) and, by contrast, a higher prevalence of cesarean deliveries in the complete CCS prophylaxis group (75.72 vs. 63.02%). As for neonatal outcomes, the low Apgar score in the first and fifth min was significantly more prevalent in the incomplete CCS prophylaxis group compared with the complete CCS prophylaxis group. The group of incomplete CCS prophylaxis reported a higher occurrence of the following outcomes: IVH grade 3-4 (7.81 vs. 3.74%, p < 0.05), PVL (7.29 vs. 1.99% p < 0.05), ROP (23.96 vs. 18.06% p = 0.062), and RDS (84.38 vs. 78.83% p = 0.085). After adjusting for covariates, the complete CCS prophylaxis group in single pregnancies was significantly protective for IVH grade 3-4, PVL, and low Apgar's scores. Similar results were found in multiple pregnancies except for RDS.DiscussionThis retrospective single-center cohort study found that, compared with preterm infants treated with 24mg betamethasone in utero, those given half course of betamethasone had a significantly higher prevalence of IVH grade 3-4, PVL, RDS, and lower Apgar scores at 1 and 5 min. In conclusion, the evidence from this single-center retrospective study supports the preference for the complete CCS prophylaxis in women at risk of preterm birth because of its beneficial effect on the main adverse outcomes.

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“…To establish whether beneficial effects may still ensue, an incomplete course of antenatal corticosteroids was associated with reduction in the need for vasopressors, the rate of IVH and neonatal death in preterm neonates in one study 30 . One dose of AGC given 4–24 hours before delivery was clinically comparable in terms of reduction of IVH and mortality with the recommended schedule of the NIH in surfactant‐treated preterm infants 30−32 …”

Section: Incomplete Coursesmentioning

confidence: 99%

Use of tocolytics: what is the benefit of gaining 48 hours for the fetus?

Renzo

Saleh

Mattei³

et al. 2006

BJOG

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Preterm birth remains one of the serious problems in perinatal medicine and is associated with an increased risk of neonatal complications and long‐term morbidity. Although each day that delivery is delayed between 22 and 28 weeks of gestation increases survival by 3%, since most spontaneous preterm labour occurs between 28 and 34 weeks of gestation, this is of secondary concern; the primary goal of delay is to improve the function of certain systems in the fetus and to balance the risks of a hostile intrauterine environment with the complications of extrauterine preterm life. Although there is a lack of definitive evidence that tocolytic drugs improve outcome following spontaneous preterm labour and preterm birth, there is ample evidence that tocolysis delays delivery for long enough to permit administration of a complete course of antepartum glucocorticoids and to facilitate in utero transfer to a tertiary care unit where neonatal care will be optimal. Both these measures have been associated with improved outcomes; antepartum glucocorticoids reduce the incidence of respiratory distress syndrome, intraventricular haemorrhage, periventricular leucomalacia and necrotising enterocolitis, and in utero transfer is associated with decreased morbidity and mortality and less hospital‐based intervention compared with postnatal transportation. Consequently, women who are more likely to benefit from tocolysis are those at early gestational ages, those needing transfer to a hospital that can provide neonatal intensive care and those who have not yet received a full course of antepartum glucocorticosteroids. In these cases, delaying labour for at least 48 hours with drugs such as atosiban should be considered, since it offers clear advantages for the fetus.

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Efficacy of a single dose of antenatal steroid in surfactant-treated babies under 31 weeks' gestation

Cited by 23 publications

References 14 publications

Effect of Prenatal Glucocorticoids on Cerebral Vasculature of the Developing Brain

Effect of Prenatal Glucocorticoids on Cerebral Vasculature of the Developing Brain

Partial vs. complete course of antenatal corticosteroid prophylaxis: An Italian single center retrospective study

Use of tocolytics: what is the benefit of gaining 48 hours for the fetus?

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