“…15,16 Compared with term neonates, late-preterm neonates are highly prone to developing tachypnea of the newborn, which is self-limiting. 17 Our analysis and others have not found benefit of antenatal corticosteroids in reducing respiratory distress in the late-preterm neonate. These findings may suggest differing efficacy of antenatal corticosteroids in developing countries compared with developed countries or other population differences that should be considered when late-preterm antenatal corticosteroids are administered.
Authors' Data Sharing Statement
Will individual participant data be available (including data dictionaries)?…”
OBJECTIVE:
To evaluate the efficacy of antenatal corticosteroids in reducing neonatal respiratory complications when administered to those at risk of preterm delivery between 34 and 36 6/7 weeks of gestation.
METHODS:
This was a single-center, triple-blind, randomized, placebo-controlled trial in southern India enrolling pregnant participants at risk of preterm delivery between 34 and 36 6/7 weeks of gestation. Computer-generated block randomization was used with participants randomized to either one course of intramuscular betamethasone or placebo. The primary outcome was a composite of treatment for respiratory distress in the neonate, defined as need for oxygen or continuous positive airway pressure or mechanical ventilation for at least 2 hours in the first 72 hours of life. Neonatal secondary outcomes were transient tachypnea of the newborn, respiratory distress syndrome, necrotizing enterocolitis, sepsis, hyperbilirubinemia, hypoglycemia, stillbirth, and early neonatal death; maternal secondary outcomes were chorioamnionitis, postpartum hemorrhage, puerperal fever, and length of hospitalization. All analyses were based on intention to treat. A sample size of 1,200 was planned with 80% power to detect a 30% reduction in rates of respiratory distress. After a planned interim analysis, enrollment was stopped for futility.
RESULTS:
From March 2020 to August 2022, 847 participants were recruited, with 423 participants randomized to betamethasone and 424 participants randomized to placebo. There were 22 individuals lost to follow-up. There was no statistically significant difference in the primary outcome (betamethasone 4.9% vs placebo 4.8%, relative risk 1.03, 95% CI, 0.57–1.84, number needed to treat 786). There were no statistically significant differences in secondary neonatal or maternal outcomes.
CONCLUSION:
Betamethasone administered in the late preterm period to those at risk for preterm delivery did not reduce the need for treatment of neonatal respiratory distress.
CLINICAL TRIAL REGISTRATION:
Clinical Trials Registry of India, CTRI/2019/09/021321.
“…15,16 Compared with term neonates, late-preterm neonates are highly prone to developing tachypnea of the newborn, which is self-limiting. 17 Our analysis and others have not found benefit of antenatal corticosteroids in reducing respiratory distress in the late-preterm neonate. These findings may suggest differing efficacy of antenatal corticosteroids in developing countries compared with developed countries or other population differences that should be considered when late-preterm antenatal corticosteroids are administered.
Authors' Data Sharing Statement
Will individual participant data be available (including data dictionaries)?…”
OBJECTIVE:
To evaluate the efficacy of antenatal corticosteroids in reducing neonatal respiratory complications when administered to those at risk of preterm delivery between 34 and 36 6/7 weeks of gestation.
METHODS:
This was a single-center, triple-blind, randomized, placebo-controlled trial in southern India enrolling pregnant participants at risk of preterm delivery between 34 and 36 6/7 weeks of gestation. Computer-generated block randomization was used with participants randomized to either one course of intramuscular betamethasone or placebo. The primary outcome was a composite of treatment for respiratory distress in the neonate, defined as need for oxygen or continuous positive airway pressure or mechanical ventilation for at least 2 hours in the first 72 hours of life. Neonatal secondary outcomes were transient tachypnea of the newborn, respiratory distress syndrome, necrotizing enterocolitis, sepsis, hyperbilirubinemia, hypoglycemia, stillbirth, and early neonatal death; maternal secondary outcomes were chorioamnionitis, postpartum hemorrhage, puerperal fever, and length of hospitalization. All analyses were based on intention to treat. A sample size of 1,200 was planned with 80% power to detect a 30% reduction in rates of respiratory distress. After a planned interim analysis, enrollment was stopped for futility.
RESULTS:
From March 2020 to August 2022, 847 participants were recruited, with 423 participants randomized to betamethasone and 424 participants randomized to placebo. There were 22 individuals lost to follow-up. There was no statistically significant difference in the primary outcome (betamethasone 4.9% vs placebo 4.8%, relative risk 1.03, 95% CI, 0.57–1.84, number needed to treat 786). There were no statistically significant differences in secondary neonatal or maternal outcomes.
CONCLUSION:
Betamethasone administered in the late preterm period to those at risk for preterm delivery did not reduce the need for treatment of neonatal respiratory distress.
CLINICAL TRIAL REGISTRATION:
Clinical Trials Registry of India, CTRI/2019/09/021321.
“…TTN is one of the most common causes of neonatal respiratory distress [23]. It is a benign, self-limited condition due to a delay in fetal lung fluid clearing after birth.…”
Section: Critical Appraisal Of the Evidencementioning
confidence: 99%
“…The incidence of TTN is inversely proportional to gestational age and affects approximately 10% of infants delivered between 33 and 34 weeks and less than 1% of term infants. The traditional diagnosis of TTN is based on clinical characteristics and CXR, even if CXR findings are nonspecific for TTN [23]. Wang et al [24] conducted a meta-analysis (6 studies, 617 patients) to determine the diagnostic value of LUS for TTN.…”
Section: Critical Appraisal Of the Evidencementioning
Background: Respiratory problems are frequent in newborns, and are mainly studied with chest X-rays, whereas CT scans are usually needed for the evaluation of rare malformations and diseases. Lung ultrasound (LUS] has been proposed as an alternative method of diagnosing a variety of respiratory conditions. In recent years, there has been a rapid increase in LUS studies, thanks to the ability of LUS to rapidly exclude complications and significantly reduce radiation exposure in this fragile population. We aimed to summarize the current knowledge about LUS. Methods: A literature search was conducted on the Medline and Cochrane databases using appropriate terms. The inclusion criteria were: English language and human species. Exclusion criteria were: non-English language, animal species, case reports, case series, non-systematic reviews, and editorials. Results: The search returned 360 results. No Cochrane reviews were found. Titles and abstracts were screened, and 37 were finally considered. Studies concerning the use of lung ultrasound for the following conditions were presented: neonatal respiratory distress syndrome, transient tachypnea of the newborn, pneumothorax, pulmonary hemorrhage, pneumonia, bronchopulmonary dysplasia, and prediction of extubation success. Conclusions: We discussed the utility of LUS for the diagnosis and treatment of neonatal diseases according to the most recent literature.
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