Past and Present: A Review of Antenatal Corticosteroids and Recommendations for Late Preterm Birth Steroids

Dixon, Christopher L.; Too, Gloria; Saade, George R.; Gyamfi-Bannerman, Cynthia

doi:10.1055/s-0038-1653944

Cited by 12 publications

(4 citation statements)

References 109 publications

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“…Some studies support improved respiratory outcomes for infants administered steroids in the late preterm period, while others do not show these improved outcomes and instead demonstrate an increased risk of adverse outcomes, such as neonatal hypoglycemia and sepsis. 47 48 49 50 51 Data regarding rescue course of steroids is similarly inconsistent. 52 53 54 55 56 57 Given these inconsistencies regarding perinatal benefit to late preterm and rescue ACS, as well as the suppression of the maternal immune response associated with steroid administration, we recommend all late preterm antenatal steroids and rescue courses to be withheld during the pandemic.…”

Section: Limited Use Of Antenatal Corticosteroids Beyond 34 Weeks or mentioning

confidence: 99%

General Guidelines in the Management of an Obstetrical Patient on the Labor and Delivery Unit during the COVID-19 Pandemic

et al. 2020

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Novel coronavirus disease 2019 (COVID-19) is a respiratory tract infection that was first identified in China. Since its emergence in December 2019, the virus has rapidly spread, transcending geographic barriers. The World Health Organization and the Centers for Disease Control and Prevention have declared COVID-19 as a public health crisis. Data regarding COVID-19 in pregnancy is limited, consisting of case reports and small cohort studies. However, obstetric patients are not immune from the current COVID-19 pandemic, and obstetric care will inevitably be impacted by the current epidemic. As such, clinical protocols and practice on labor and delivery units must adapt to optimize the safety of patients and health care workers and to better conserve health care resources. In this commentary, we provide suggestions to meet these goals without impacting maternal or neonatal outcomes. Key Points • Novel coronavirus disease 2019 (COVID-19) is a pandemic.• COVID-19 impacts care of obstetric patients.• Health care should be adapted for the COVID-19 pandemic.

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Section: Limited Use Of Antenatal Corticosteroids Beyond 34 Weeks or mentioning

confidence: 99%

General Guidelines in the Management of an Obstetrical Patient on the Labor and Delivery Unit during the COVID-19 Pandemic

et al. 2020

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“…임신나이 34주에서 36주까지의 후기 조산은 전체 조산의 71%, 모든 분만의 약 8.7%를 차지한다고 알려져 있다 1) . 후기 조산아는 34주 이전에 태어나는 조산아들에 비해 그 정도가 덜하기는 하지만 37주 이후에 태어나는 만삭아들과 비교하면 신생아 시기에 호흡곤 란으로 신생아중환자실에 입원하여 환기보조치료를 받게 되는 경 우가 많다.…”

Section: 서론unclassified

The Effect of Incompletely Administered Antenatal Corticosteroids on Neonatal Pulmonary Outcomes in Late Preterm Infants

Kim

Jung

et al. 2022

Neonatal Med

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Purpose: Recent obstetric guidelines recommend the administration of antenatal corticosteroids in pregnant women at risk of delivering infants at a gestational age between 34 and 36 weeks. We examined the effect of incompletely administered antenatal corticosteroids on the neonatal pulmonary outcomes in late preterm infants.Methods: Late preterm infants (34<sup>+0</sup> to 36<sup>+6</sup> weeks gestational age) born at the Seoul National University Bundang Hospital from January 2019 to June 2020 were retrospectively enrolled. We excluded multiple births except twins, those with major congenital anomalies, deaths, or transfers to other hospitals. An incomplete course of antenatal corticosteroids was defined as one in which the first or the second dose of betamethasone was administered within 24 hours before delivery. The rates of neonatal pulmonary morbidities were compared between late preterm infants given incomplete courses antenatal corticosteroids and their peers who not given antenatal corticosteroids; these morbidities included respiratory distress syndrome and transient tachypnea of the newborn, assisted ventilation including invasive mechanical ventilation, nasal continuous positive airway pressure and high-flow nasal cannula, and admission to neonatal intensive care unit.Results: Logistic regression models were constructed while adjusting for factors which were significant in bivariate models. After adjusting for baseline maternal and neonatal characteristics, we found no significant differences in the rates of neonatal pulmonary morbidities, assisted ventilation, or admission to the neonatal intensive care unit between late preterm infants who received incomplete antenatal corticosteroid therapy and their peers who were not given any antenatal corticosteroids.Conclusion: Incompletely administered antenatal corticosteroids did not significantly alter the neonatal pulmonary outcomes in late preterm infants.

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“…Especially the late PTB model, PCA30d, could be used to clarify some research questions typically encountered in this late preterm period. For example, there is still a heated debate around the question on how to address growth restriction [40] during this specific gestation and subsequently the infant respiratory [41] and neonatal morbidity [10,42].…”

Section: Plos Onementioning

confidence: 99%

Earlier preterm birth is associated with a worse neurocognitive outcome in a rabbit model

et al. 2021

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Background Preterm birth (PTB) and particularly late preterm PTB has become a research focus for obstetricians, perinatologists, neonatologists, pediatricians and policy makers alike. Translational models are useful tools to expedite and guide clinical but presently no model exists that contextualizes the late PTB scenario. Herein we aimed to develop a rabbit model that echo’s the clinical neurocognitive phenotypes of early and late PTB. Methods Time mated rabbit does underwent caesarean delivery at a postconceptional age (PCA) of either 28 (n = 6), 29 (n = 5), 30 (n = 4) or 31 (n = 4) days, term = 31 d. Newborn rabbits were mixed and randomly allocated to be raised by cross fostering and underwent short term neurobehavioral testing on corrected post-natal day 1. Open field (OFT), spontaneous alteration (TMT) and novel object recognition (NORT) tests were subsequently performed at 4 and 8 weeks of age. Results PTB was associated with a significant gradient of short-term mortality and morbidity inversely related to the PCA. On postnatal day 1 PTB was associated with a significant sensory deficit in all groups but a clear motor insult was only noted in the PCA 29d and PCA 28d groups. Furthermore, PCA 29d and PCA 28d rabbits had a persistent neurobehavioral deficit with less exploration and hyperanxious state in the OFT, less alternation in TMT and lower discriminatory index in the NORT. While PCA 30d rabbits had some anxiety behavior and lower spontaneous alteration at 4 weeks, however at 8 weeks only mild anxiety driven behavior was observed in some of these rabbits. Conclusions In this rabbit model, delivery at PCA 29d and PCA 28d mimics the clinical phenotype of early PTB while delivery at PCA 30d resembles that of late PTB. This could serve as a model to investigate perinatal insults during the early and late preterm period.

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Past and Present: A Review of Antenatal Corticosteroids and Recommendations for Late Preterm Birth Steroids

Cited by 12 publications

References 109 publications

General Guidelines in the Management of an Obstetrical Patient on the Labor and Delivery Unit during the COVID-19 Pandemic

General Guidelines in the Management of an Obstetrical Patient on the Labor and Delivery Unit during the COVID-19 Pandemic

The Effect of Incompletely Administered Antenatal Corticosteroids on Neonatal Pulmonary Outcomes in Late Preterm Infants

Earlier preterm birth is associated with a worse neurocognitive outcome in a rabbit model

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