Optimizing antenatal corticosteroid therapy for improving outcome of premature infants

Watterberg, Kristi L.; Ballard, Philip L.

doi:10.1038/s41390-019-0538-x

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…15 Furthermore, most animal studies of ACS based maternal dosing on weight. 16,17 However, our results show that weight-based dosing of ACS is not necessary in humans.…”

Section: Discussionmentioning

confidence: 71%

“…When initially studied by Liggins and Howie in 1972, 18 the previously mentioned dose was selected arbitrarily. 16 This dose continues to be recommended today 5,19 with no clear attempts to optimise the dose, despite the prevalence of obesity being significantly higher than when the dosage was initially established. A study in sheep observed similar maternal and foetal concentrations of ACSs at lower doses to the traditionally recommended dosing regimen.…”

Section: Discussionmentioning

confidence: 99%

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Antenatal corticosteroids, maternal body mass index and infant morbidity within the ASTEROID trial

Hofer

McKinlay

Tran

et al. 2020

Aust NZ J Obst Gynaeco

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The prevalence of obesity among women is increasing and has become a significant problem worldwide. 1 In New Zealand, approximately 30% of women have a body mass index (BMI) of ≥30 kg/m 2 . 2 Obesity and being overweight are therefore prevalent among women giving birth and are associated with increased risks for pre-eclampsia, gestational diabetes and preterm birth, particularly extremely preterm birth, leading to poor health outcomes. 3 Antenatal corticosteroid (ACS) administration before preterm birth improves infant health by accelerating development, especially of the lung, thereby reducing neonatal mortality and morbidity, including respiratory distress syndrome (RDS) and intraventricular haemorrhage (IVH). 4 Clinical

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“…15 Furthermore, most animal studies of ACS based maternal dosing on weight. 16,17 However, our results show that weight-based dosing of ACS is not necessary in humans.…”

Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Antenatal corticosteroids, maternal body mass index and infant morbidity within the ASTEROID trial

Hofer

McKinlay

Tran

et al. 2020

Aust NZ J Obst Gynaeco

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“…Vricella et al [16] have reported that blood volume rises with adiposity; for thisreason, it is expected that the volume of distribution for ACS dosing alter with increasing BMI [16]. In addition, most animal studies on ACS based maternal dosing on weight [17,18]. In a amimal study Schmidt AF et al [18] they report the pharmacokinetics and pharmacodynamics of oral dosing of ACS using a preterm sheep model.…”

Section: P R E P R I N Tmentioning

confidence: 99%

The interaction of maternal obesity and administered betamethasone in the development of fetal respiratory distress syndrome

Şahin

et al. 2023

Arch Med Sci

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IntroductionThe current study evaluated the effect of obesity on neonatal respiratory distress syndrome (RDS) in pregnant women who were administered ACSs due to the risk of preterm birth and delivered before 34 weeks of gestation.Material and methodsIn this retrospective study, 414 pregnant women who had a singleton pregnancy, were aged 18–40 years, and received two doses of ACS 24 h apart administered between 23+0/7 and 33+5/7 gestation weeks due to the risk of a preterm birth were included. For maximum fetal effect, those who completed the 48-hour steroid treatment and delivered before 34 weeks of gestation were divided into three groups according to BMI at ACS administration.ResultsGestational age at ACS administration and gestational age at delivery were similar among groups.. Neonatal RDS occurred in 17 (18.6%) newborns in the normal weight group, 40 (17.1%) newborns in the overweight group, and 23 (25.5%) newborns in the obese group. After adjusting for independent effects from maternal age, gestational age at ACS administration, gestational age at delivery, emergency cesarean delivery, fetal birth weight, and fetal gender, we found that RDS rates were significantly higher in the obese group.ConclusionsOur results suggest that maternal obesity reduces the effects of ACS and that RDS rates are higher in neonates born before 34 weeks of gestation to obese mothers to whom ACS has been administered.Therefore, pregnant women who have a high BMI and who are at risk of preterm birth are more likely to require an adjustment in ACS dosing.

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“…They recommend administering prenatal corticosteroids, in risky pregnancies, between 26 and 34 weeks, for two days and, it is not advisable to use repeated doses if the birth has not occurred after one week of the last dose since It has not shown additional benefits. The medications recommended in these guidelines are Betamethasone 12,13 . Despite the available evidence on the use of pulmonary maturation with corticosteroids in the threat of preterm birth, there is a possibility of using the rescue dose if the birth has not occurred after seven days of the last dose.…”

Section: Introductionmentioning

confidence: 99%

Differences between preterm infants receiving a dose for lung maturation and those receiving an additional rescue dose of corticosteroids

Poma

González-Andrade

2021

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it is unknown if there is a difference between preterm infants with a history of receiving pulmonary corticosteroid maturation or using an additional rescue dose of corticosteroid. This paper aims to determine the difference between infants with pulmonary maturation and infants who received a rescue dose of corticosteroid. We performed an epidemiological, observational, and cross-sectional study. We analyzed time of stay, the requirement of mechanical ventilation, the use of surfactant, and neurological complications in newborns hospitalized in Neonatology of the Isidro Ayora Gyneco-Obstetric Hospital, 2019. We analyzed 204 preterm infants of 28-37 weeks who received a total lung maturation dose versus an added rescue dose. We analyzed the information with the statistical program SPSS v 22.0. With rescue dose the stay time was 28.4±21.6 days (p <0.05), days of invasive mechanical ventilation 3±5.7 days (p <0.05); Surfactant use 33.3% (p>0.05). We found neurological complications in 6.9% of patients (p> 0.05). In group 2 with not rescue dose use, the stay time was 21.5±16.6 days (p<0.05), days of invasive mechanical ventilation 1.8 ± 4.1 days (p <0.05). Surfactant use was 24.5% (p>0.05), and neurological complications 2% (p> 0.05). Preterm males weighing <1000 g from 30 to 32 weeks, who used rescue doses of corticosteroids, showed an increase in intraventricular hemorrhage (13.7%), seizures (6.9%), and leukomalacia (13.7%), associated with the fact that in the group with rescue dose they are younger and had lower weight.

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Optimizing antenatal corticosteroid therapy for improving outcome of premature infants

Cited by 5 publications

References 18 publications

Antenatal corticosteroids, maternal body mass index and infant morbidity within the ASTEROID trial

Antenatal corticosteroids, maternal body mass index and infant morbidity within the ASTEROID trial

The interaction of maternal obesity and administered betamethasone in the development of fetal respiratory distress syndrome

Differences between preterm infants receiving a dose for lung maturation and those receiving an additional rescue dose of corticosteroids

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