The Effect of Antenatal Steroids on Fetal Lung Maturation between the 34th and 36th Week of Pregnancy

Balcı, Osman; Özdemir, Suna; Mahmoud, Alaa S.; Acar, Ali; Çolakoğlu, Mehmet

doi:10.1159/000295898

Cited by 66 publications

(60 citation statements)

References 34 publications

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“…16,17 However, these studies were inconclusive as they were underpowered, 17 had substantial loss to follow-up, 16 and had post-randomization exclusions. 17 …”

Section: Discussionmentioning

confidence: 99%

Antenatal Betamethasone for Women at Risk for Late Preterm Delivery

et al. 2016

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Background Infants born at 34 to 36 weeks’ gestation (late preterm) have greater risks of adverse respiratory and other outcomes, than those born at 37 weeks gestation or later. It is not known whether betamethasone administered to women at risk for late preterm delivery decreases risks of neonatal morbidities. Methods We conducted a multicenter randomized trial of women with a singleton gestation at high risk for late preterm delivery. Participants were randomized to two injections of 12 mg betamethasone or matching placebo 24 hours apart. The primary outcome was a neonatal composite of treatment in the first 72 hours (continuous positive airway pressure or high flow nasal cannula for at least two hours, supplemental oxygen with a fraction of inspired oxygen of at least 30 percent for at least four hours, extra corporeal membrane oxygenation or mechanical ventilation) or stillbirth or neonatal death before 72 hours. Results 2,831 patients were randomized. The primary outcome occurred in 11.6% of the betamethasone group versus 14.4%, in the placebo group (Relative Risk 0.80, 95% confidence interval 0.66-0.97, P=0.02). Severe respiratory morbidity, transient tachypnea of the newborn, surfactant use, and bronchopulmonary dysplasia were also significantly less common in the betamethasone group. There were no significant differences between groups in the incidence of chorioamnionitis or neonatal sepsis. Neonatal hypoglycemia was more common in the betamethasone group. (24.0% versus 14.9%, RR 1.61, 95% CI 1.38-1.88, P<0.001) Conclusions Administration of betamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory morbidity.

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“…16,17 However, these studies were inconclusive as they were underpowered, 17 had substantial loss to follow-up, 16 and had post-randomization exclusions. 17 …”

Section: Discussionmentioning

confidence: 99%

Antenatal Betamethasone for Women at Risk for Late Preterm Delivery

et al. 2016

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“…Two smaller randomized trials have specifically assessed the use of betamethasone in the late preterm period to prevent adverse neonatal respiratory outcomes. 16,17 However, these studies were inconclusive as they were underpowered, 17 had substantial loss to follow-up, 16 and had post-randomization exclusions. 17 We found that infants exposed to antenatal betamethasone had a higher rate of neonatal hypoglycemia defined as glucose <40mg/dL.…”

Section: Discussionmentioning

confidence: 99%

Antenatal Betamethasone for Women at Risk for Late Preterm Delivery

Smith

2016

N Engl J Med

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“…Estimation of fetal lung maturity might reduce the use of corticosteroids in late preterm deliveries (34 to 36 weeks of gestation), for which the risk of NRM is relevant but relatively low, ranging 10% to 20%. As recently shown, steroids decrease by one-third the occurrence of NRM in late preterm deliveries [8, 31- 34] and the number needed to treat to reduce one case of NRM in the circumstances described is 25 [8]. These findings have resulted in the publication of a Society for Maternal-Fetal Medicine statement on the use of antenatal corticosteroids in the late preterm period [35]; it recommends treatment under the strict inclusion criteria of the Antenatal Late Preterm Steriods study, while warning against overtreatment in those cases that do not meet the inclusion criteria.…”

Section: Commentmentioning

confidence: 99%

Prediction of neonatal respiratory morbidity by quantitative ultrasound lung texture analysis: a multicenter study

Palacio¹,

Bonet‐Carne²,

Cobo³

et al. 2017

American Journal of Obstetrics and Gynecology

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Background Prediction of neonatal respiratory morbidity may be useful to plan delivery in complicated pregnancies. The limited predictive performance of the current diagnostic tests together with the risks of an invasive procedure restricts the use of fetal lung maturity assessment. Objective The objective of this study was to evaluate the performance of quantitative ultrasound texture analysis of the fetal lung (quantusFLM) to predict neonatal respiratory morbidity in preterm and early-term (<39.0 weeks) deliveries. Study Design This was a prospective multicenter study conducted in 20 centers worldwide. Fetal lung ultrasound images were obtained at 25.0-38.6 weeks of gestation within 48 hours of delivery, stored in Digital Imaging and Communication in Medicine format, and analyzed with quantusFLM. Physicians were blinded to the analysis. At delivery, perinatal outcomes and the occurrence of neonatal respiratory morbidity, defined as either respiratory distress syndrome or transient tachypnea of the newborn, were registered. The performance of the ultrasound texture analysis test to predict neonatal respiratory morbidity was evaluated. Results A total of 883 images were collected, but 17.3% were discarded because of poor image quality or exclusion criteria, leaving 730 observations for the final analysis. The prevalence of neonatal respiratory morbidity was 13.8% (101/730). The quantusFLM predicted neonatal respiratory morbidity with a sensitivity, specificity, and positive and negative predictive values of 74.3% (75/101), 88.6% (557/629), 51.0% (75/147), and 95.5% (557/583), respectively. Accuracy was 86.5% (632/730), and the positive and negative likelihood ratios were 6.5 and 0.3, respectively. Conclusion The quantusFLM predicted neonatal respiratory morbidity with an accuracy similar to that previously reported for other tests with the advantage of being a non-invasive technique.

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The Effect of Antenatal Steroids on Fetal Lung Maturation between the 34th and 36th Week of Pregnancy

Cited by 66 publications

References 34 publications

Antenatal Betamethasone for Women at Risk for Late Preterm Delivery

Antenatal Betamethasone for Women at Risk for Late Preterm Delivery

Antenatal Betamethasone for Women at Risk for Late Preterm Delivery

Prediction of neonatal respiratory morbidity by quantitative ultrasound lung texture analysis: a multicenter study

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