Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study

Asztalos, Elizabeth; Murphy, Kellie; Willan, Andrew R.; Matthews, Stephen G.; Ohlsson, Arne; Saigal, Saroj; Armson, B. Anthony; Kelly, Edmond; Delisle, Marie-France; Gafni, Amiram; Lee, Shoo K.; Sananes, Renée; Rovet, Joanne; Guselle, Patricia; Amankwah, Kofi; Saleem, Mariam; Sanchez, Johanna

doi:10.1001/jamapediatrics.2013.2764

Cited by 69 publications

(56 citation statements)

References 41 publications

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“…The WHO recommends that a single repeat course of steroids may be considered if preterm birth does not occur within 7 days after the initial course and subsequent assessment demonstrates that there is a high risk of preterm birth in the next 7 days [24]. It is unlikely that repeat courses given after 32 weeks' gestation improve outcome, and recent long-term follow-up studies show no benefit by school age in terms of reduction in death or disability if repeat courses are used [25]. …”

Section: Prenatal Carementioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

et al. 2016

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Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Section: Prenatal Carementioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

et al. 2016

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“…In MACS-5, infants born at term who were exposed as fetuses to multiple courses of ACS had a higher risk of the composite outcome of death or survival with a neurodevelopmental or neurosensory disability [10]. These findings are consistent with animal studies where repeated ACS treatment was associated with impairment of axonal myelination in the optic nerve, prolonged auditory brainstem responses, and slower neural transmission times [11-13].…”

Section: Introductionmentioning

confidence: 66%

“…The major concerns are for adverse effects on fetal growth and neurodevelopment. In MACS-5, children who were exposed to multiple courses of ACS in utero had reduced weight, length, and head circumference at birth [4], and those who were born at term had an almost 4-fold increased risk of neurosensory difficulties at 5 years of age [9, 10]. …”

Section: Discussionmentioning

confidence: 99%

“…Recent research suggests that repeated doses of ACS are associated with an increased incidence of neurosensory disabilities in childhood, especially in children delivered after 34 weeks of gestation [8-10]. In MACS-5, infants born at term who were exposed as fetuses to multiple courses of ACS had a higher risk of the composite outcome of death or survival with a neurodevelopmental or neurosensory disability [10].…”

Section: Introductionmentioning

confidence: 99%

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Antenatal Corticosteroid Exposure Disrupts Myelination in the Auditory Nerve of Preterm Sheep

Rittenschober-Böhm

Rodger²,

Jobe

et al. 2018

Neonatology

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Background: Antenatal corticosteroids (ACS) improve preterm neonatal outcomes. However, uncertainty remains regarding the safety of ACS exposure for the developing fetus, particularly its neurosensory development. Objectives: We investigated the effect of single and multiple ACS exposures on auditory nerve development in an ovine model of pregnancy. Methods: Ewes with a single fetus (gestational age [GA] 100 days) received an intramuscular injection of 150 mg medroxyprogesterone-acetate, followed by intramuscular (i) betamethasone (0.5 mg/kg) on days 104, 111, and 118 GA; (ii) betamethasone on day 104 and saline on days 111 and 118 GA; or (iii) saline on days 104, 111, and 118 GA, with delivery on day 125 GA. Transmission electron microscope images of lamb auditory nerve preparations were digitally analyzed to determine auditory nerve morphology and myelination. Results: Relative to the control, mean auditory nerve myelin area was significantly increased in the multiple-treatment group (p < 0.001), but not in the single-treatment group. Increased myelin thickness was significantly changed only in a subgroup analysis for those axons with myelin thickness greater than the median value (p < 0.001). Morphological assessments showed that the increased myelin area was due to an increased likelihood of decompacted areas (p = 0.005; OR = 2.14, 95% CI 1.26–3.63; 31.6 vs. 18.2% in controls) and irregular myelin deposition (p = 0.001; OR = 5.91, 95% CI 2.16–16.19; 49.0 vs. 16.8% in controls) in the myelin sheath. Conclusions: In preterm sheep, ACS exposure increased auditory nerve myelin area, potentially due to disruption of normal myelin deposition.

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“…Repeating the antenatal BM dosage is another issue that has been debated and consensus has not yet been reached despite a number of well-designed randomized trials [14,15,16,17]. No studies with DX have been reported.…”

Section: Influence Of New Neonatal Management Practices On the Effectmentioning

confidence: 99%

The Story of Antenatal Steroid Therapy before Preterm Birth

Hallman

2015

Neonatology

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Antenatal glucocorticoid has proven to be one of the most successful single therapeutic approaches for preventing serious consequences after preterm birth. The fetal compartment is protected against endogenous corticosteroid by the high endogenous 11β-hydroxysteroid dehydrogenase type 2 that converts cortisol to cortisone and by the poor responsiveness of the fetal hypothalamus to corticotropin-releasing hormone. High corticosteroid activity acutely enhances the functional maturity of the fetus. Persistently high fetal glucocorticoid activity has adverse effects on the growth and differentiation of the fetal brain and other organs. Intrauterine growth restriction may be associated with high fetal glucocorticoid activity. Antenatal glucocorticoid therapy which is aimed to be given within 1-10 days before preterm birth is likely to increase the success of postnatal noninvasive treatments of very preterm infants.

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Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study

Abstract: clinicaltrials.gov Identifier: NCT00187382.

Cited by 69 publications

References 41 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

Antenatal Corticosteroid Exposure Disrupts Myelination in the Auditory Nerve of Preterm Sheep

The Story of Antenatal Steroid Therapy before Preterm Birth

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