Fetal Lung Maturation, the Respiratory Distress Syndrome, and Antenatal Steroid Therapy

Fetal growth restriction in singletons has been shown to enhance fetal lung maturation and reduce the risk of respiratory distress syndrome due to increased endogenous steroid production. However, data on lung maturation in growth-discordant monochorionic (thus, identical) twins are lacking. Our objective was to compare the risk of severe neonatal morbidity between the larger and the smaller twin in monochorionic twins with birth weight discordance (BWD). We included in the study all consecutive monochorionic diamniotic pregnancies with severe BWD (≥25%) and two live-born twins delivered at our center (n = 47 twin pairs). We compared the incidence of neonatal morbidity, particularly respiratory distress syndrome (RDS), and cerebral lesions between the larger and the smaller co-twin. The incidence of severe neonatal morbidity in the larger and smaller twin was 38% (18/47) and 19% (9/47), respectively (odds ratio (OR) 2.66, 95% confidence interval (CI) 0.94–7.44) and was due primarily to the higher incidence of RDS, 32% (15/47) and 6% (3/47), respectively (OR 6.88, 95% CI 1.66–32.83). In conclusion, this study shows that the larger twin in monochorionic twin pairs with BWD is at increased risk of severe neonatal morbidity, particularly RDS, compared to the smaller twin.

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Retracted: Antenatal Steroid Therapy for Fetal Lung Maturation and the Subsequent Risk of Childhood Asthma: A Longitudinal Analysis

Journal of Pregnancy ◽

10.1155/2016/6212584 ◽

2016 ◽

Vol 2016 ◽

pp. 1-1

Keyword(s):

Steroid Therapy ◽

Longitudinal Analysis ◽

Childhood Asthma ◽

Fetal Lung ◽

Lung Maturation ◽

Antenatal Steroid ◽

Fetal Lung Maturation ◽

Subsequent Risk

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The Relationship between Maternal Hypertensive Disease of Pregnancy and the Incidence of Idiopathic Respiratory Distress Syndrome

PEDIATRICS ◽

10.1542/peds.65.4.735 ◽

1980 ◽

Vol 65 (4) ◽

pp. 735-739 ◽

Cited By ~ 1

Author(s):

Jing Ja Yoon ◽

Schuyler Kohl ◽

Rita G. Harper

Keyword(s):

Mortality Rate ◽

Respiratory Distress Syndrome ◽

Gestational Age ◽

Distress Syndrome ◽

Fetal Lung ◽

Hypertensive Disease ◽

Lung Maturation ◽

Idiopathic Respiratory Distress Syndrome ◽

Fetal Lung Maturation ◽

The Relationship

The relationship between maternal hypertensive disease of pregnancy (HDOP) and idiopathic respiratory distress syndrome (IRDS) was analyzed in 2,105 premature infants weighing between 1,000 and 2,199 gm and born between January 1968 and December 1975 at the Kings County Hospital Center and State University Hospital. HDOP was diagnosed in 250 mothers of 2,105 infants studied. The incidence of IRDS (15.2%) in the HDOP group was significantly lower than the 29.9% in the non-HDOP group (P < .001). In infants whose gestational age was 32 weeks or less, the incidence of IRDS was 26.1% in the HDOP group and 40.8% in the non-HDOP group (P < .01). In infants whose gestational age was 33 weeks or more, the incidence (9.3%) in the HDOP group was significantly lower than the 18.4% in the non-HDOP group (P < .005). The low incidence of IRDS in the HDOP group remained even after eliminating infants with known predisposing and protecting factors from the development of IRDS. The incidence of IRDS was inversely related to the severity of maternal toxemia. The total mortality and mortality with IRDS were not significantly different in both HDOP and non-HDOP groups. When the infants did not develop IRDS, the mortality rate in the HDOP group was significantly higher than that in the non-HDOP group especially in the lower gestational age group. These data suggest that chronic stress accelerates fetal lung maturation and severe chronic stress is even more effective in accelerating fetal lung maturation. When maternal toxemia was severe enough to accelerate the fetal lung maturation, the mortality rate of the infants without IRDS increased.

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Antenatal Steroid Therapy for Fetal Lung Maturation: Is There an Association with Childhood Asthma?

Journal of Asthma ◽

10.1080/02770900802262795 ◽

2009 ◽

Vol 46 (1) ◽

pp. 47-52 ◽

Cited By ~ 15

Author(s):

Jason D. Pole ◽

Cameron A Mustard ◽

Teresa To ◽

Joseph Beyene ◽

Alexander C. Allen

Keyword(s):

Steroid Therapy ◽

Childhood Asthma ◽

Fetal Lung ◽

Lung Maturation ◽

Antenatal Steroid ◽

Fetal Lung Maturation

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Predictors of mortality in premature babies with respiratory distress syndrome treated by early rescue surfactant therapy

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-190244 ◽

2021 ◽

pp. 1-6

Author(s):

V. Gahlawat ◽

H. Chellani ◽

I. Saini ◽

S. Gupta

Keyword(s):

Mechanical Ventilation ◽

Birth Weight ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Surfactant Therapy ◽

Mask Ventilation ◽

Predictors Of Mortality ◽

Antenatal Steroid ◽

Bag And Mask Ventilation

OBJECTIVE: To determine the predictors of mortality following early rescue surfactant therapy in preterm babies with respiratory distress syndrome. STUDY DESIGN: Prospective cohort study enrolling babies between 28 weeks to 34 weeks with respiratory distress syndrome requiring early rescue surfactant therapy. For statistical analysis babies were further divided into two subgroups: survivors and non-survivors. Maternal and neonatal variables were compared between the two groups to find out the predictors of mortality. RESULTS: Out of total 110 babies, 72 (65.45%) survived. The mean birth weight and mean gestational age of the study population was 1614.36 (±487.86) g and 31.40 (±2.0)1 weeks, respectively. Birth weight < 1500 g, gestational age < 32 weeks, primiparity, vaginal delivery, prolonged rupture of membranes, lack of antenatal steroid cover, bag and mask ventilation at birth, sepsis, apneic episodes and mechanical ventilation were significantly associated with death on univariate analysis. On multivariate analysis, very low birth weight, vaginal delivery, lack of antenatal steroid cover, bag and mask ventilation at birth and mechanical ventilation were found to be independent predictors of mortality. CONCLUSIONS: Some of the identified predictors of mortality are modifiable and can be used to draw up a screening tool to predict the clinical severity and mortality among these babies.

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A Controlled Trial of Antepartum Glucocorticoid Treatment for Prevention of the Respiratory Distress Syndrome in Premature Infants, by G. C. Liggins, MB, PhD, FRCOG, and R. N. Howie, MB, MRACP, Pediatrics, 1972;50:515–525

PEDIATRICS ◽

10.1542/peds.102.s1.250 ◽

1998 ◽

Vol 102 (Supplement_1) ◽

pp. 250-252

Author(s):

Mary Ellen Avery

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Controlled Trial ◽

Fetal Lung ◽

Hyaline Membrane Disease ◽

Treated Group ◽

Premature Delivery ◽

Glucocorticoid Treatment ◽

Increased Risk

A controlled trial of betamethasone therapy was carried out in 282 mothers in whom premature delivery threatened or was planned before 37 weeks' gestation, in the hope of reducing the incidence of neonatal respiratory distress syndrome by accelerating functional maturation of the fetal lung. A total of 213 mothers were in spontaneous premature labor. When necessary, ethanol or salbutamol infusions were used to delay delivery while steroid or placebo therapy was given. Delay for at least 24 hours was achieved in 77% of the mothers. In these unplanned deliveries, early neonatal mortality was 3.2% in the treated group and 15.0% in the control subjects. There were no deaths with hyaline membrane disease or intraventricular cerebral hemorrhage in infants of mothers who had received betamethasone for at least 24 hours before delivery. The respiratory distress syndrome occurred less often in treated babies (9.0%) than in controls (25.8%), but the difference was confined to babies of <32 weeks' gestation who had been treated for at least 24 hours before delivery (11.8% of the treated babies compared with 69.6% of the control babies). There may be an increased risk of fetal death in pregnancies complicated by severe hypertension–edema–proteinuria syndromes and treated with betamethasone, but no other hazard of steroid therapy was noted. We conclude that this preliminary evidence justifies additional trials, but that additional work is needed before any new routine procedure is established.

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