Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes

Crowther, Caroline A; McKinlay, Christopher J.D.; Middleton, Philippa; Harding, Jane E.

doi:10.1002/14651858.cd003935.pub4

Cited by 194 publications

(116 citation statements)

References 78 publications

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“…The recent Cochrane systematic review included 9 other randomized trials of repeat antenatal corticosteroid treatment, with varying number, frequency, and dose(s) of corticosteroids. 1 Although the meta-analysis confirmed that repeat antenatal corticosteroid treatment is associated with neonatal benefits, 1 broadly similar to those seen in our trial, some heterogeneity of effect was observed, including 2 trials that showed no apparent benefit. 4,5 Until this heterogeneity is adequately explained and later childhood outcomes are reported for different treatment regimens, we recommend that the inclusion criteria and treatment schedule used in our trial be followed.…”

Section: Discussionsupporting

confidence: 78%

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Mid-Childhood Outcomes of Repeat Antenatal Corticosteroids: A Randomized Controlled Trial

et al. 2016

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To assess if exposure to repeat dose(s) of antenatal corticosteroids has beneficial effects on neurodevelopment and general health in mid-childhood, at 6 to 8 years' corrected age. METHODS:Women at risk for very preterm birth, who had received a course of corticosteroids ≥7 days previously, were randomized to intramuscular betamethasone (11.4 mg Celestone Chronodose) or saline placebo, repeated weekly if risk of very preterm birth remained. Midchildhood assessments included neurocognitive function, behavior, growth, lung function, blood pressure, health-related quality of life, and health service utilization. The primary outcome was survival free of neurosensory disability. RESULTS:Of the 1059 eligible long-term survivors, 963 (91%) were included in the primary outcome; 479 (91%) in the repeat corticosteroid group and 484 (91%) in the placebo group. The rate of survival free of neurosensory disability was similar in both groups (78.3% repeat versus 77.3% placebo; risk ratio 1.00, 95% confidence interval, 0.94-1.08). Neurodevelopment, including cognitive function, and behavior, body size, blood pressure, spirometry, and health-related quality of life were similar in both groups, as was the use of health services. CONCLUSIONS:Treatment with repeat dose(s) of antenatal corticosteroids was associated with neither benefit nor harm in mid-childhood. Our finding of long-term safety supports the use of repeat dose(s) of antenatal corticosteroids, in view of the related neonatal benefits. For women at risk for preterm birth before 32 weeks' gestation, ≥7 days after an initial course of antenatal corticosteroids, clinicians could consider using a single injection of betamethasone, repeated weekly if risk remains.

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Section: Discussionsupporting

confidence: 78%

“…1 Systematic review of 4 trials 2 -5 that have reported on health outcomes in early childhood after repeat dose(s) of antenatal corticosteroids found no differences between exposed or unexposed children. 1 However, the efficacy and safety effects on health in later childhood are unknown.…”

mentioning

confidence: 99%

Mid-Childhood Outcomes of Repeat Antenatal Corticosteroids: A Randomized Controlled Trial

et al. 2016

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“…opublikowali w kolejnych latach wyniki metaanaliz potwierdzające skuteczność podawania steroidów [3]. Wyniki powyższych badań ujawniły, że podawanie steroidów prenatalnie od 34 tygodnia ciąży przyspiesza dojrzewanie płuc płodu i stymuluje produkcję surfaktantu, co zabezpiecza noworodki urodzone przedwcześnie przed zespołem zaburzeń oddychania oraz krwawieniami dokomorowymi [4,5,6]. Zmiany hemodynamiczne towarzyszące płodom z wewnątrzmacicznym ograniczeniem wzrastania płodu (intrauterine growth restriction -IUGR), zwią-zane głównie z zaburzeniem budowy lub funkcji łoży-ska w drugiej połowie ciąży, powodują uruchomienie swoistych mechanizmów adaptacyjnych umożliwiają-cych przetrwanie płodu w warunkach niedotlenienia.…”

Section: Wst ęPunclassified

Influence of steroid prophylaxis on prenatal and postnatal parameters in fetuses with intrauterine growth restriction

Grzegórzko

Gibala

Gębicka

et al. 2018

Ann. Acad. Med. Siles.

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ST RESZCZ ENIE WSTĘP :Podawanie steroidów w ciąży do 34 hbd przyspiesza rozwój dojrzałości płuc płodu i stymuluje wydzielanie surfaktantu, przez co zapobiega występowaniu zespołu zaburzeń oddychania. Udowodniono, że podawanie steroidów prenatalnie powoduje czasowe obniżenie akcji serca płodu o adekwatnej masie ciała (AGA). W pracy podjęto próbę odpowiedzi na pytanie: jak długo utrzymuje się czasowe obniżenie akcji serca płodu (fetal heart rate -FHR) po podaniu steroidów u płodów z wewnątrzmacicznym ograniczeniem wzrastania? MAT ER IAŁ I METO D Y:Badanie przeprowadzono z udziałem 152 pacjentek Kliniki Ginekologii i Położnictwa SUM w Katowicach, hospitalizowanych w latach 2013-2016, podzielonych na dwie grupy: AGA -109 przypadków, IUGR -43 przypadki. W obu grupach została włączona profilaktyka steroidowa -betametazon lub deksametazon. Przeanalizowano zapisy KTG oraz MONAKO wykonane przy przyjęciu pacjentki oraz 24 i 48 godzin po podaniu steroidów, oceniając linię podstawową, epizody bradykardii oraz parametry zmienności LTV i STV. Wyniki opracowano w programie Statistica 12PL. WYN I KI : Bradykardia posteroidowa występowała częściej w grupie AGA niż w grupie IUGR. Po podaniu pierwszej dawki steroidów zauważono istotnie niższą wartość FHR w czasie trwania epizodów bradykardii w grupie AGA niż w grupie IUGR (p = 0,0001). Obniżenie FHR bez bradykardii było znamiennie większe w grupie AGA niż w grupie IUGR (p = 0,0001). Średnia wartość STV po podaniu drugiej dawki steroidów była znamiennie niższa w grupie AGA niż w grupie IUGR (p = 0,006). Ciśnienie parcjalne tlenu było wyższe w grupie IUGR (p = 0,001). WN IOS KI : W świetle powyższych wyników wydaje się, że płody z IUGR wykazują lepszą tolerancję podawanych steroidów manifestującą się rzadszym występowaniem bradykardii i wyższymi wartościami STV oraz mniejszymi wahaniami wartości FHR.

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“…These medications have been shown to accelerate the maturation of the fetal lungs and thus, enhance the survival of the infant at preterm delivery [83,84]. In addition to the effects in the newborn's lungs, the administration of glucocorticoids has also been observed to increase mean arterial blood pressure, renal blood flow and glomerular filtration rate [85][86][87] this in turn, has the potential to affect renal function.…”

Section: Glucocorticoidsmentioning

confidence: 99%

Preterm Birth and/or Factors that Lead to Preterm Delivery: Effects on the Neonatal Kidney

Ryan¹,

Black²

2015

J Neonatal Biol

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Preterm birth (defined as birth prior to 37 completed weeks of gestation), occurs in approximately 10% of all births and is one of the leading causes of neonatal morbidity and mortality worldwide. Preterm infants are born at a time when kidney development is still ongoing, and consequently can lead to renal impairment (in both the short-term and long-term), as well as severe glomerular abnormalities in some preterm infants. Since the glomerular abnormalities are not present in all preterm kidneys, this suggests that it is not preterm birth per se that leads to the glomerular abnormalities but may relate to factors associated with the etiology of the premature delivery, or factors in neonatal care. In this review, we provide an overview of what is currently known of how prenatal and postnatal factors can potentially impact on the immature kidneys of infants born preterm.

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Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes

Cited by 194 publications

References 78 publications

Mid-Childhood Outcomes of Repeat Antenatal Corticosteroids: A Randomized Controlled Trial

Mid-Childhood Outcomes of Repeat Antenatal Corticosteroids: A Randomized Controlled Trial

Influence of steroid prophylaxis on prenatal and postnatal parameters in fetuses with intrauterine growth restriction

Preterm Birth and/or Factors that Lead to Preterm Delivery: Effects on the Neonatal Kidney

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