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

Abstract

CONTEXT: Although the benefits of antenatalcorticosteroids have been widely demonstrated in other countries, there are few studies among Brazilian newborn infants. OBJECTIVE:To evaluate the effectiveness of antenatal corticosteroids on the incidence of respiratory distress syndrome and intra-hospital mortality among neonates with a gestational age of less than 34 weeks. TYPE OF STUDY:Cross-sectional. SETTING:A tertiary-care hospital. PARTICIPANTS:Neonates exposed to any dose of antenatal corticosteroids for fetal maturation up to 7 days before delivery, and newborns paired by sex, birth weight, gestational age and time of birth that were not exposed to antenatal corticosteroids. The sample obtained consisted of 205 exposed newborns, 205 non-exposed and 39 newborns exposed to antenatal corticosteroids for whom it was not possible to find an unexposed pair. PROCEDURES:Analysis of maternal and newborn records. MAIN MEASUREMENTS:The primary clinical outcomes for the two groups were compared: the incidence of respiratory distress syndrome and intra-hospital mortality; as well as secondary outcomes related to neonatal morbidity. RESULTS:Antenatal corticosteroids reduced the occurrence of respiratory distress syndrome (OR: 0.33; 95% CI: 0.21-0.51) and the protective effect persisted when adjusted for weight, gestational age and the presence of asphyxia (adjusted OR: 0.27; 95% CI: 0.17-0.43). The protective effect could also be detected through the reduction in the need for and number of doses of exogenous surfactant utilized and the number of days of mechanical ventilation needed for the newborns exposed to antenatal corticosteroids. Their use also reduced the occurrence of intra-hospital deaths (OR: 0.51: 95% CI: 0.38-0.82). However, when adjusted for weight, gestational age, presence of prenatal asphyxia, respiratory distress syndrome, necrotizing enterocolitis and use of mechanical ventilation, the antenatal corticosteroids did not maintain the protective effect in relation to death. With regard to other outcomes, antenatal corticosteroids reduced the incidence of intraventricular hemorrhage grades III and IV (OR: 0.28; 95% CI: 0.10-0.77). CONCLUSIONS:Antenatal corticosteroids were effective in the reduction of morbidity and mortality among premature newborns in the population studied, and therefore their use should be stimulated within our environment.

Incidence of periventricular/intraventricular hemorrhage in very low birth weight infants: a 15-year cohort study

“…Um trabalho nacional demonstrou que o uso antenatal de corticosteroide reduziu significativamente a ocorrência de formas graves de HPIV em recém-nascidos pré-termo 17 . No entanto, a utilização do medicamento no Brasil ainda não tem ocorrido de modo generalizado e padronizado.…”

“…Tais práticas estão englobadas no que tem sido denominado como implementação de melhores práticas para prevenção de hemorragia cerebral e lesão cerebral isquêmica em recém-nascidos de muito baixo peso ao nascer [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] .…”

Parâmetros hematológicos e perfil bioquímico renal de cordeiros nascidos a termo e prematuros

“…Outro indício de dano renal isquêmico pode ser obtido por meio do perfil bioquímico do animal, a partir de elevadas concentrações séricas de creatinina (Kaneko, 2008). O uso exógeno de corticoides durante o período pré-natal em mulheres gestantes tem reduzido significativamente a incidência de bebês com "síndrome da angústia respiratória", o tempo de ventilação mecânica, o número de doses de surfactantes utilizados, além da ocorrência de quadros de hemorragia peri-intraventricular (Meneguel et al, 2003). Em cordeiros, os efeitos descritos são similares e podem ser justificados pelo aumento de lipídeos e proteínas do surfactante pulmonar (Ballard et al, 1997).…”

“…O procedimento anestésico adotado nas cirurgias cesarianas foi realizado por meio de anestesia local com bloqueio paravertebral proximal nos ramos nervosos das vértebras T13, L1 e L2, utilizando- A concentração plasmática de proteína total foi determinada utilizando-se refratômetro clínico (Master-SUR/NM, ATAGO, Tóquio, Japão), e o teor plasmático de fibrinogênio obtido pelo método de precipitação pelo calor e pela leitura em refratômetro (Millar et al, 1971).…”

Effect of antenatal corticosteroid on early neonatal outcome in preterm neonates: a prospective observational study

“…Respiratory distress syndrome continues to be the most important pulmonary problem during the neonatal period, affecting a large number of premature infants. 1 Corticosteroids interact with specific receptor proteins in the target tissue as it regulates the expression of the genes that are responsive to corticosteroids and hence, disposition of the proteins synthesized by the various target tissues are altered. 2 In this way, corticosteroids assist in achieving a successful transition from fetal to extra-uterine life, accelerating fetal maturation as a whole.…”