Sinnvolle Steroidprophylaxe bei drohender Frühgeburt – State of the art

Abstract

The aim of this work is to provide an overview of the recommendations in the current literature for the induction of lung maturation therapy. In particular, special attention is focused on specific situations, such as chorioamnionitis, intrauterine growth retardation and preeclampsia, which often lead to premature birth. Additionally, some aspects of antenatal steroid therapy, despite its widespread use, still require clarification. Among them is the repetitive administration of steroid therapy. On the basis of the Cochrane analysis of 2015, advantages and disadvantages for children and pregnant women are explained. Furthermore, the data on the use of antenatal steroid therapy in multiple pregnancies remain insufficient.

Inadequate Timing Limits the Benefit of Antenatal Corticosteroids on Neonatal Outcome: Retrospective Analysis of a High-Risk Cohort of Preterm Infants in a Tertiary Center in Germany

“…Our results also confirm previous data 3 , 4 and demonstrate that a completed course of ACS reduces neonatal mortality by 83% compared to no ACS and by 67% compared to an incomplete ACS course. We also report a significant reduction of NEC and the need for ventilation as shown in Table 1 in agreement to recent studies and meta-analysis 1 , 3 , 31 . This underlines the need and benefits of a full course of ACS before the delivery of a preterm infant whenever possible.…”

“…Data of extremely low birthweight infants (ELBW < 1000 g) are still rare 3 , 5 , 6 . ACS enhances maturation of pulmonary structure and function 1 , 7 , 8 . Nevertheless, it is still unknown how long these beneficial effects last.…”

“…Every additional day between ACS and delivery increased the risk for ventilation by 4.5 % and for surfactant administration by 5 %. Subgroup analysis revealed sig-Introduction Administration of antenatal corticosteroids (ACS) in threatened premature birth (PTB) before 34 weeks of gestation (wks) is stated to be the most effective treatment known for preventing serious preterm complications in the newborn including respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC), as well as reducing overall mortality [1,2]. Betamethasone 12 mg twice or dexamethasone 4 × 6 mg decrease mortality and morbidity markedly for preterm infants especially in very low birthweight infants (VLBW < 1500 g) [3,4].…”