Useless Perinatal Therapies

Abstract

With respect to Professor Bengt Robertson whose research studies were very instrumental in the development of one of the most important and evidence-based therapies in perinatal medicine, namely surfactant therapy, I thought it might be appropriate to review some useless or harmful perinatal therapies. Although the term ‘neonatology’ has only been in existence for about 50 years, care of the newborn in the 19th century was largely provided by nurses and obstetricians. As an example, Pierre Budin, a Parisian obstetrician, was very aware of the importance of keeping low birth weight babies warm. More recently however, a number of useless or harmful practices were adopted by those caring for pregnant women and their babies. These included uncontrolled oxygen supplementation, inadequate temperature control, withholding feeds, and various drugs such as thalidomide, chloramphenicol, hexachlorophene, sodium bicarbonate, Epsom salts, benzyl alcohol, thyrotrophin-releasing hormone and corticosteroids. Even in the modern age, inappropriate therapies have been introduced on the basis of short-term beneficial outcomes without longer-term evaluation. Sometimes we are slow to learn the lessons of the past.

Avoiding the prenatal programming effects of glucocorticoids: are there alternative treatments for the induction of antenatal lung maturation?

“…As for risk reduction for RDS, in animal models, chorioamnionitis increased the surfactant pool, improved lung compliance, and reduced the risk for RDS. Similar effects on lung maturation were found after intra-amniotic injection of lipopolysaccharides (LPS) [21,51,71,76,111] .…”

Randomised Controlled Trials for Informing Perinatal Care

“…Analysis did not show any treatment benefits but demonstrated higher mortality in infants allocated to receive corticitropin. This seminal study illustrates how the young discipline of neonatology aimed to assess new interventions using a "fair test"; however, many other examples exist where interventions were introduced without supporting trial-based evidence, sometimes with adverse consequences that were not revealed for many years (5). A salutary example is the association of supplemental oxygen with retinopathy of prematurity in preterm infants (6).…”

Skin Physiology of the Newborn and Topical Drug Use

“…Perkütan emilim preterm bebeklerde term bebeklerden çok daha yüksek düzeydedir 1,2,13 . Tablo 2'de yenidoğanda, bir kısmı tıbbi amaçla deriye topikal olarak uygulanan çeşitli etken maddelerin perkütan emilimine bağlı geliştiği rapor edilen istenmeyen durumlar özetlenmektedir 1,2,5,[7][8][9][10][11][12][13]17 . Bununla birlikte pretermlerin term yaşıtlarının epidermal yetilerini yakalaması için gereken 2-3 haftalık sürede var olan yüksek epidermal geçirgenlik teofilin ve diamorfin gibi bazı ilaçların topikal kullanımına imkan vermektedir 1,2,6,15,17 .…”

“…Bu dönemde iyatrojenik durumlar dahil çok çeşitli dermatolojik sorun sık olarak yaşanmaktadır. [6][7][8][9][10][11][12] Bu durumun temel nedeni; diğer organ sistemleri ile birlikte derinin anatomik bütünlüğe rağmen henüz matürasyonunu tamamlamamış olmasıdır [3][4][5][6][7][8][9][10][11] . Yenidoğan deri fizyolojisinin iyi bilinmesi, bu dönemde karşılaşılabilecek deriye ait yetersizlikler ve sorunların ön görülebilmesi ile uygun topikal tedavinin seçilmesinin yanı sıra gereksiz ya da zararlı olabilecek topikal uygulamaların önlenmesine katkı sağlayacaktır.…”