Prevention of the Respiratory Distress Syndrome in Premature Infants by Antepartum Glucocorticoid Therapy

Abstract

Summary A trial of antepartum dexamethasone therapy was carried out in 55 mothers in whom premature delivery threatened between 28 to 36 weeks gestation in the hope of reducing the incidence of respiratory distress syndromes (RDS). The control group was made up of 62 mothers who delivered prematurely in the same gestational age without any treatment. In the treated group isoxsuprine was used to delay delivery when necessary. The respiratory distress syndrome occurred less often in the treated group of infants (8.3 per cent) than in the controls (35.2 per cent; p<0.001). The difference was more marked in babies of under 32 weeks gestation. Considering only cases with intact membranes the incidence of RDS was significantly (p<0.01) lower in the treated group. Early neonatal mortality was 6.6 per cent in the treated group and 38 per cent (p<0.0001) in the controls. In 12 cases the L/S ratio was measured during dexamethasone administration and in the majority of these the L/S ratio rose sharply to mature values following treatment. This rise was observed as soon as 48 hours after beginning of dexamethasone. Antepartum isoxsuprine in the treated group had no apparent effect on the incidence of RDS. No adverse effects of steroid therapy were observed. This trial confirms the studies of others that antepartum glucocorticoid can significantly reduce the incidence of RDS in premature infants.

Antenatal Dexamethasone Administration Increases Fetal Lung DNA Synthesis and RNA and Protein Content in Nitrofen-Induced Congenital Diaphragmatic Hernia in Rats

“…The beneficial effects of antenatal glucocorticoid therapy are now well established as a means of promoting lung maturation and preventing respiratory distress syndrome in premature infants (4,5). The similarities between the lungs of babies who die from CDH and the lungs of premature infants with respiratory distress syndrome suggest a possible role for prenatal glucocorticoids in enhancing lung maturation in CDH.…”

“…Antenatal Dex (0.25 mg/kg) or normal saline was administered intraperitoneally on d 18.5 and 19.5 of gestation. The dose and timing of Dex administration were chosen as it approximates dose and timing currently used in human pregnancy to hasten maturation of fetal lungs (4,5), and it is known to be the lowest effective dose that has resulted in biochemical and morphologic improvement with the least effect on somatic and pulmonary growth (6). The fetuses were divided into three groups: nonnitrofen, non-CDH, and nonsteroid (control, n ϭ 16); nitrofen-induced CDH (CDH, n ϭ 16); and nitrofen-induced CDH with antenatal Dex treatment (CDH ϩ Dex, n ϭ 16).…”

“…Recently, antenatal administration of glucocorticoid has been proposed as a noninvasive modality in promoting fetal lung maturation and differentiation. Several control trials have shown the beneficial effects of antenatal glucocorticoid therapy as a means of promoting lung maturation and preventing respiratory distress syndrome in premature human newborns (4,5). In experimentally produced CDH in animals, it has been reported that antenatal glucocorticoid treatment improves surfactant biochemical immaturity, increases lung compliance and distensibility, enhances lung morphology, and reduces pulmonary vascular adventitial and medial thickness (6 -11).…”

Antenatal treatment with corticosteroids for preterm neonates: impact on the incidence of respiratory distress syndrome and intra-hospital mortality

“…After this classic study, many others were made. [5][6][7][8][9][10][11][12][13][14][15][16] Nevertheless, these studies were not enough to stimulate the routine use of antenatal corticosteroids in obstetric practice. This situation persisted until 1990, when Crowley et al 17 brought together 12 controlled studies of good methodological quality in a meta-analysis.…”

Intraamniotic Triidothyronine instillation for prevention of respiratory distress syndrome in pregnancies complicated by hypertension

“…LIGGINS and HOWIE [14] first reported the beneficial effect of the maternal administration of antepartum glucocorticoid on the incidence of RDS in premature infants. This has since been confirmed by others [3,5,8,18]. However, attention must be drawn to the possibility of an adverse effect of corticosteroid treatment in cases with hypertensionedema-proteinuria syndromes.…”