Impact of a ‘rescue course’ of antenatal corticosteroids: a multicenter randomized placebo-controlled trial

Garite, Thomas J.; Kurtzman, James; Maurel, Kimberly; Clark, Reese H.

doi:10.1016/j.ajog.2009.01.021

Cited by 137 publications

(127 citation statements)

References 15 publications

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“…The most recent Cochrane Review concludes that further research is needed before repeat courses of antenatal steroids can be routinely recommended [18] . Since this update, another large randomised trial has been published showing early benefits of a rescue course of betamethasone when birth has not occurred after the first course [23] . Multiple pregnancy may be a situation in which a repeat course may offer added benefit [24,25] .…”

Section: P R E N a T A L C A R Ementioning

confidence: 99%

European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants – 2010 Update

Sweet

Carnielli²,

Greisen³

et al. 2010

Neonatology

232

175

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These updated guidelines contain new evidence from recent Cochrane reviews and the medical literature since 2007. Many of the previous recommendations regarding early surfactant and CPAP are now more firmly evidence-based. The section on delivery room stabilisation has been considerably expanded. There are new recommendations on delaying umbilical cord clamping and a new section has been added on avoiding or reducing duration of mechanica l ventilation, including recommendations on caf feine t herapy, nasal ventilation, permissive hypercapnia and the role of newer ventilator modalities. A new 'miscellaneous' section has also been added covering aspects of RDS management that arise infrequently.© For permitted use only.

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Section: P R E N a T A L C A R Ementioning

confidence: 99%

European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants – 2010 Update

Sweet

Carnielli²,

Greisen³

et al. 2010

Neonatology

232

175

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“…However, there was an almost significant association between multiple ANS courses and the risk of cerebral palsy (p = 0.06) [27] . The randomized trials studying the effect of a single repeat course of betamethasone showed a decrease in the risk of RDS, without early growth retardation and no evidence on adverse neurological outcome at the corrected age of two years [28,30,31] . The follow-up studies are not complete yet.…”

Section: Therapies Enhancing Maturity Of Fetuses With Threatened Pretmentioning

confidence: 94%

Enhancing Functional Maturity before Preterm Birth

2010

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Enhancing functional maturity of the high-risk preterm fetus is aimed at decreasing the life-threatening neonatal disorders that increase the burden of chronic disease. A course of antenatal glucocorticoids before 35 weeks of pregnancy substitutes endogenous activation of the hypothalamic-adrenal axis that spontaneously enhances functional maturity and augments cytokine-induced preterm lung maturity. It is the main fetal therapy that decreases the functional prematurity-related neonatal morbidity in the era of surfactant therapy. Tocolytic agents potentiate the effect of glucocorticoids on the fetus. Repeating an antenatal glucocorticoid course may be recommended if the preterm fetus remains undelivered for more than 7 days and very preterm birth is imminent. However, the follow-up results are still incomplete, and available preliminary studies warn against adverse neurological and metabolic consequences following several antenatal repeat courses of glucocorticoids. Administration of glucocorticoids after 34 weeks of pregnancy may be considered in selected high-risk cases, preferably with documented lung immaturity. We recommend delaying elective delivery in low-risk pregnancies without established lung maturity until 40 weeks, unless labor starts earlier. In a selected high-risk population 17α-hydroxyprogesterone acetate decreases the prematurity rate. However, this drug has a limited impact on functional maturity of the preterm fetus and its effects on the development of the child remain to be studied further.

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“…Although there has been limited evidence to date to support this, a recently published, randomized study with nearly 500 patients showed that a second course of antenatal steroids administered up to 32 weeks of gestation-with a minimal interval of 2 weeks from the first course-can improve neonatal outcome without increasing short-term risks [25]. In specific clinical situations (e.g., first course of steroids administered very early in the pregnancy, e.g., 24 weeks of gestation, followed by deterioration of the situation 4-6 weeks later), the authors believe that a single repeated course of steroids (''rescue course'') can be justified.…”

Section: Repeated Courses Of Antenatal Corticosteroids?mentioning

confidence: 99%

Antenatal corticosteroids for fetal lung maturation in threatened preterm delivery: indications and administration

Surbek

Drack

Irion

et al. 2012

Arch Gynecol Obstet

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The standard regimen of antenatal corticosteroids involves a single course of 2 × 12 mg betamethasone administered intramuscularly within 24 h. The administration of corticosteroids usually is performed between 24 and 34 weeks gestation. However, under particular circumstances it may be beneficial even at 23 weeks and at 35-36 weeks of gestation. The evidence to date is clearly against the routine administration of multiple antenatal steroid courses. In special clinical situations, a second course of betamethasone ("rescue course") may be justifiable. Tocolysis during administration of steroids is not routinely indicated in the absence of contractions, cervical shortening or rupture of membranes.

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Impact of a ‘rescue course’ of antenatal corticosteroids: a multicenter randomized placebo-controlled trial

Cited by 137 publications

References 15 publications

European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants – 2010 Update

European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants – 2010 Update

Enhancing Functional Maturity before Preterm Birth

Antenatal corticosteroids for fetal lung maturation in threatened preterm delivery: indications and administration

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