Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth

Abstract

The evidence from this new review supports the continued use of a single course of antenatal corticosteroids to accelerate fetal lung maturation in women at risk of preterm birth. A single course of antenatal corticosteroids should be considered routine for preterm delivery with few exceptions. Further information is required concerning optimal dose to delivery interval, optimal corticosteroid to use, effects in multiple pregnancies, and to confirm the long-term effects into adulthood.

The Prevention, Diagnosis and Treatment of Premature Labor

“…The treatment consists of two 12 mg doses of betamethasone given intramuscularly 24 hours apart, or four 6 mg doses of dexamathasone given intramuscularly 12 hours apart. Antenatal corticosteroid treatment has been found to lower neonatal mortality (OR 0.69, 95% CI 0.58-0.81; 18 trials including 3956 children), the risk of neonatal respiratory distress syndrome (OR 0.66, 95% CI 0.59-0.73; 21 trials in 4083 children), the frequency of cerebral intraventricular hemorrhage (OR 0.54, 95% CI 0.43-0.69; 13 trials in 2872 children), and the frequency of necrotizing enterocolitis (OR 0.46, 95% CI 0.29-0.74; eight trials in 1675 children) (33). This clear benefit for the neonates is also present if there is an incipient amniotic fluid infection syndrome; thus, prolongation of pregnancy is also sensible in this group of patients in order to permit the induction of lung maturation.…”

Does the corticosteroid’s treatment during the pre and postnatal period affect the neurodevelopmental outcome of premature newborns?

“…Desde que en 1972 se introdujo el uso de corticoides en el periodo prenatal, este se ha asociado con una reducción del riesgo de síndrome de dificultad respiratoria, mortalidad, hemorragia intraventricular, conducto arterial persistente, enterocolitis necrosante y, probablemente, retinopatía del prematuro (13). Con base en la evidencia acumulada, desde 1994 los National Institutes of Health de los Estados Unidos recomiendan la administración de Correspondencia: Marita Lardón, Calle Gilbert Clos Portal 2, nº 3, 2º I, C.P: 18500, Guádix, Granada, España Teléfono: (34) 685 849 748 arrayamar@hotmail.com Recibido: 14/06/16; aceptado: 18/10/16 corticoides en el periodo prenatal para todas las pacientes con riesgo de parto prematuro antes de las 34 semanas de gestación.…”

Quantitative fetal fibronectin predicts preterm birth in women with bulging fetal membranes

“…A c c e p t e d M a n u s c r i p t 12 after 7 days [3] and repeated courses after this timeframe have been shown to reduce morbidity in preterm infants but with adverse effects on fetal growth [13], accurate timing is essential. qfFN could be a useful guide to target the group at highest risk, and avoid premature dosing.…”

“…Interventions such as timely antenatal steroid administration and in-utero transfer to specialist units have been shown to improve neonatal mortality and morbidity [3,4]. In women with bulging fetal membranes (BFM) at early gestations -a particularly high-risk group -the use of rescue cervical cerclage can delay delivery by approximately 5 weeks [5][6][7].…”