Respiratory distress syndrome and antenatal corticosteroid treatment in premature twins

BACKGROUND: Preterm birth remains a major health issue worldwide. Preterm delivery affects over 7–12% of births in India and is responsible for up to 75% of neonatal deaths. Despite advances in medical technology, the prevalence of preterm birth is increasing. Discovery of antenatal corticosteroid for fetal maturation and its adoption into clinical practice highlights several fascinating and universal truths about science and medicine. The challenge in human studies is to demonstrate antenatal corticosteroid administration in pregnancy contributes to developmental programming and how this is manifested in later life. The World Health Organization recommends the use of one course of antenatal steroids for all pregnant women between 26 and 35 weeks of gestation who are at risk of preterm delivery within 7 days. Both, the American College of Obstetricians and Gynaecologists and the Royal College of Obstetricians and Gynaecologists recommend their use between 24 and 34 weeks of gestation (1). The use of antenatal steroids after 34 or 35 weeks of gestation is not recommended unless there is evidence of fetal pulmonary immaturity. Despite this, antenatal steroids are widely used globally across all gestational periods. In a diverse country like India, diversity in clinical practice is a reality. Hence, the present research study intends to study the maternal and perinatal outcomes with antenatal corticosteroid administration in preterm deliveries at Government district hospital, Nandyal in South India. AIMS AND OBJECTIVES Ÿ To determine the incidence of RDS at District hospital, Nandyal among neonates delivered between 28-37 weeks due to PTL, PPROM or severe PET whose mothers received ACS and in those whose mothers did not receive ACS. Ÿ To determine the severity of RDS at District hospital, Nandyal among neonates delivered between 28-37 weeks due to PTL, PPROM or severe PET whose mothers received ACS and in those whose mothers did not receive ACS. Ÿ To compare the neonatal mortality among neonates delivered between 28-37 weeks due to PTL, PPROM or severe PET whose mothers received ACS with those whose mothers did not receive ACS. Ÿ To determine the effectiveness of antenatal corticosteroid administration in preventing early neonatal respiratory distress syndrome in early preterm labour versus late preterm labour. Ÿ To determine the effectiveness of ACS administration in preventing neonatal complications with respect to the mode of delivery. METHODOLOGY: Study was conducted at Government District Hospital, Nandyal from 01/01/2019 to 30/10/2019. A structured questionnaire was prepared under guidance of thesis guide. All pregnant women with gestational age between 28 completed weeks to 37 completed weeks, presenting in OPD either in labour or getting admitted due to any other maternal medical complication, are initially assessed thoroughly to estimate the gestational age by history, LMP, early USG, and clinical examination. They are given a course of ACS if they were not expecting delivery within next 1 hour, after explaining the benets and risks of ACS as per recommendations of Federation of International st Gynecology and Obstetrics. Those who did not receive ACS or those who delivered within 24hrs of administration of 1 dose of ACS were considered as subjects in NACS group. Those who received ACS were considered as subjects in ACS group. After delivery, the neonate is followed up in NICU until discharged or until 7 days whichever is shorter. Mother is followed up for any clinical signs of infection, until she is discharged. Data is analyzed scientically. RESULTS: In Antenatal corticosteroids group (ACS), there were 36 subjects within 20 years, 43 subjects between 20-25 years, 29 subjects between 25-30 years, 25 subjects between 30-35 years. In No Antenatal corticosteroids group (NACS), there were 32 subjects within 20 years, 49 subjects between 20-25 years, 25 subjects between 25-30 years, 10 subjects between 30-35 years. Study observed that Antenatal corticosteroids group had lower incidence of Respiratory distress syndrome compared to No Antenatal corticosteroids group (12.07% versus 23.28%). Antenatal corticosteroids group had lower incidence of severe Respiratory distress syndrome compared to No Antenatal corticosteroids group (21.3 % versus 33.33%) among those who had Respiratory Distress Syndrome. Antenatal corticosteroids group had fewer admissions to NICU than No Antenatal corticosteroids group (20.69% versus 33.62%). Antenatal corticosteroids group had lower mortality than No Antenatal corticosteroids group (12.07 % versus 22.41%). Antenatal corticosteroids group had 35 % less chances of Respiratory distress syndrome compared to No Antenatal corticosteroids group. In No Antenatal corticosteroids group, subjects who underwent vaginal delivery had 10% less risk compared to those who underwent LSCS for their neonates to have Respiratory distress syndrome. In Antenatal corticosteroids group, subjects who underwent vaginal delivery had 14.29 % less risk compared to those who underwent LSCS for their neonates to have Respiratory distress syndrome. Antenatal corticosteroids group had maternal infection rate comparable to No Antenatal Corticosteroids group. CONCLUSION: Use of antenatal corticosteroids was found to be benecial in pregnant women with Gestational age of 28 completed weeks to less than 37 completed weeks at Government District hospital, Nandyal. Antenatal corticosteroids did not have statistically signicant adverse effects (i.e. increased rate of infection) in mothers.

Download Full-text

Plurality-dependent risk of respiratory distress syndrome among very-low-birth-weight infants and antepartum corticosteroid treatment

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2005.05.058 ◽

2006 ◽

Vol 194 (1) ◽

pp. 302

Author(s):

William N. Spellacy

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Very Low Birth Weight ◽

Corticosteroid Treatment ◽

Low Birth Weight Infants

Download Full-text

Efficacy of Antenatal Corticosteroid Injection in the Prevention of Neonatal Respiratory Distress Syndrome after C-Section

10.53350/pjmhs211581874 ◽

2021 ◽

Vol 15 (8) ◽

pp. 1874-1876

Author(s):

Zainab Wali ◽

Samina Gohar ◽

Sehrish Waseem ◽

Munawar Afzal

Keyword(s):

Caesarean Section ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Elective Caesarean Section ◽

Elective Cesarean Section ◽

Years Of Experience ◽

Antenatal Corticosteroid ◽

Term Pregnancy ◽

Corticosteroid Administration

Aim: To determine the efficacy of antenatal corticosteroid in the prevention of respiratory distress syndrome of the neonates in women undergoing elective cesarean section at term pregnancy. Study design: Descriptive case series Place and duration of study: Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar from 6th December 2018 to 6th May 2019. Methodology: One hundred and seventy five women were enrolled. The women after taking complete history with obstetrical examination and antenatal corticosteroid administration i.e. 12 mg dexamethasone IM (two doses 12 hours apart) were observed. The caesarean section was performed by experienced obstetrician having minimum of five years of experience after 24 hours and within seven days of the second dose of dexamethasone. All the neonates were carefully examined in NICU for the detection of respiratory distress syndrome. All these observations were done under supervision of an expert pediatrician having minimum of five years of experience. Results: The mean age was 28±11.34 years. Thirty five percent patients had POG range 37+ weeks while 65% patients had POG range 38+ weeks. Mean POG was 37±1.12 weeks. More over antenatal corticosteroid was effective in 97% patients and was not effective in 3% patients. Conclusion: The antenatal corticosteroid was 97% effective in the prevention of respiratory distress syndrome of the neonates, in women undergoing ELSC at term after elective caesarean section for term pregnancy. Keywords: Efficacy, Antenatal corticosteroid, Respiratory distress syndrome, Neonates, Elective C- section,

Download Full-text

Antenatal Corticosteroids and Preterm Neonatal Morbidity and Mortality among Women with and without Diabetes in Pregnancy

American Journal of Perinatology ◽

10.1055/s-0040-1714391 ◽

2020 ◽

Author(s):

Ashley N. Battarbee ◽

Grecio Sandoval ◽

William A. Grobman ◽

Jennifer L. Bailit ◽

Uma M. Reddy ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Neonatal Morbidity ◽

Maternal Diabetes ◽

Differential Association ◽

Sensitivity Analyses ◽

Antenatal Corticosteroid ◽

Antenatal Corticosteroids

Objective The objective of this study was to determine whether antenatal corticosteroid exposure has a differential association with preterm neonatal morbidity among women with and without diabetes. Study Design Secondary analysis of an observational cohort of 115,502 women and their neonates born in 25 U.S. hospitals (2008–2011). Women who delivered at 230/7 to 336/7 weeks' gestation and received antenatal corticosteroids were compared with those who did not receive antenatal corticosteroids. Women with a stillbirth and women who delivered a neonate that was not resuscitated were excluded. The primary outcome was neonatal respiratory distress syndrome or death within 48 hours. Secondary outcomes included composite neonatal morbidity (respiratory distress syndrome, necrotizing enterocolitis, grades 3–4 intraventricular hemorrhage, sepsis, or death) and mechanical ventilation. Multivariable modified Poisson regression was used to estimate the association between antenatal corticosteroid exposure and neonatal outcomes. Maternal diabetes (pregestational and gestational) was evaluated as a potential effect modifier, and sensitivity analyses were conducted to evaluate whether receipt of a partial, single, or multiple course(s) of antenatal corticosteroids influenced results. Results A total of 4,429 women with 5,259 neonates met inclusion criteria: 3,716 (83.9%) women received antenatal corticosteroids and 713 (16.1%) did not. Of the 510 diabetic women (181 pregestational and 329 gestational), 439 (86.1%) received antenatal corticosteroids. Of the 3,919 nondiabetic women, 3,277 (83.6%) received antenatal corticosteroids. Antenatal corticosteroid exposure was not associated with respiratory distress syndrome or early death (adjusted relative risk [aRR] = 0.94, 95% confidence interval [CI]: 0.85–1.04), composite neonatal morbidity (aRR = 0.98, 95% CI: 0.89–1.07), or mechanical ventilation (aRR = 0.95, 95% CI: 0.86–1.05). There was no significant effect modification of maternal diabetes on the relationship between antenatal corticosteroids and neonatal outcomes (p > 0.05), and outcomes were similar in sensitivity analyses of partial, single, or multiple courses of corticosteroids. Discussion Antenatal corticosteroid administered to reduce preterm neonatal morbidity does not appear to have a differential association among women with diabetes compared with those without. Key Points

Download Full-text

Acute Respiratory Distress Syndrome After Zinc Chloride Inhalation: Survival After Extracorporeal Life Support and Corticosteroid Treatment

American Journal of Critical Care ◽

10.4037/ajcc2009908 ◽

2010 ◽

Vol 19 (1) ◽

pp. 86-90 ◽

Cited By ~ 19

Author(s):

Chih-Feng Chian ◽

Chin-Pyng Wu ◽

Chien-Wen Chen ◽

Wen-Lin Su ◽

Chin-Bin Yeh ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Life Support ◽

Extracorporeal Life Support ◽

Corticosteroid Treatment ◽

High Dose ◽

Arterial Oxygenation ◽

Bilateral Pneumothorax

No standard protocol exists for the treatment of acute respiratory distress syndrome induced by inhalation of smoke from a smoke bomb. In this case, a 23-year-old man was exposed to smoke from a smoke grenade for approximately 10 to 15 minutes without protective breathing apparatus. Acute respiratory distress syndrome developed subsequently, complicated by bilateral pneumothorax and pneumomediastinum 48 hours after inhalation. Despite mechanical ventilation and bilateral tube thoracostomy, the patient was severely hypoxemic 4 days after hospitalization. His condition improved upon treatment with high-dose corticosteroids, an additional 500-mg dose of methylprednisolone, and the initiation of extracorporeal life support. Arterial oxygenation decreased gradually after abrupt tapering of the corticosteroid dose and discontinuation of the life support. On day 16 of hospitalization, the patient experienced progressive deterioration of arterial oxygenation despite the intensive treatment. The initial treatment regimen (ie, corticosteroids and extracorporeal life support) was resumed, and the patient’s arterial oxygenation improved. The patient survived.

Download Full-text

Meta-analysis of randomized controlled trials of antenatal corticosteroid for the prevention of respiratory distress syndrome: Discussion

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(95)90223-6 ◽

1995 ◽

Vol 173 (1) ◽

pp. 335-344 ◽

Cited By ~ 53

Author(s):

John C. Sinclair

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Randomized Controlled Trials ◽

Distress Syndrome ◽

Meta Analysis ◽

Controlled Trials ◽

Antenatal Corticosteroid ◽

Randomized Controlled

Download Full-text

The Effect of Antenatal Corticosteroid Therapy to Respiratory Distress Syndrome Event on Preterm Infants in Surabaya

Biomolecular and Health Science Journal ◽

10.20473/bhsj.v1i1.8217 ◽

2018 ◽

Vol 1 (1) ◽

pp. 40

Author(s):

Devy Putri Zenita ◽

Martono Tri Utomo ◽

Ernawati Darmawan

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Corticosteroid Therapy ◽

Premature Infants ◽

Protective Factor ◽

Distress Syndrome ◽

Premature Baby ◽

Premature Delivery ◽

Antenatal Corticosteroid ◽

Dose Administration

ABSTARCTIntroductions: One of the most common cause of morbidity and mortality in premature infants is respiratory distress syndrome (RDS). Several studies have shown that a single dose administration of antenatal corticosteroid therapy in women who are at high risk for premature delivery was associated with decreased incidence of RDS. The study aims to determine the effect of antenatal corticosteroid therapy on the incidence of RDS in prematurity in the Department of Child Health Hospital Dr. Soetomo.Methods: Analytic observational case-control design study was used for this research. Samples were taken from the medical records of RDS patients in premature baby and non-RDS with 36 samples in each group.Results: Antenatal corticosteroid therapy has effect in RDS incidence (p = 0.016). While the results of the odds ratio was 0.298 (with 95% CI 0.110 to 0.810), it means that premature infants with antenatal corticosteroid therapy has 0.298 times lower risk than those who were not given antenatal corticosteroid therapy.Conclusion: Antenatal corticosteroid therapy did not provide a direct relathionship to the incidence of respiratory distress syndrome in premature infants, but it a protective factor that can reduce the incidence of RDS in prematurity.

Download Full-text

The Controversy About the Effects of Different Doses of Corticosteroid Treatment on Clinical Outcomes for Acute Respiratory Distress Syndrome Patients: An Observational Study

Frontiers in Pharmacology ◽

10.3389/fphar.2021.722537 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jia-Wei Yang ◽

Ping Jiang ◽

Wen-Wen Wang ◽

Zong-Mei Wen ◽

Bei Mao ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Systemic Corticosteroid ◽

Corticosteroid Treatment ◽

Apache Ii Score ◽

High Dose ◽

High Dose Corticosteroid ◽

Dose Corticosteroid

Background: Corticosteroid usage in acute respiratory distress syndrome (ARDS) remains controversial. We aim to explore the correlation between the different doses of corticosteroid administration and the prognosis of ARDS.Methods: All patients were diagnosed with ARDS on initial hospital admission and received systemic corticosteroid treatment for ARDS. The main outcomes were the effects of corticosteroid treatment on clinical parameters and the mortality of ARDS patients. Secondary outcomes were factors associated with the mortality of ARDS patients.Results: 105 ARDS patients were included in this study. Corticosteroid treatment markedly decreased serum interleukin-18 (IL-18) level (424.0 ± 32.19 vs. 290.2 ± 17.14; p = 0.0003) and improved arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (174.10 ± 65.28 vs. 255.42 ± 92.49; p < 0.0001). The acute physiology and chronic health evaluation (APACHE II) score (16.15 ± 4.41 vs. 14.88 ± 4.57, p = 0.042) decreased significantly on the seventh day after systemic corticosteroid treatment. Interestingly, the serum IL-18 decreased significantly (304.52 ± 286.00 vs. 85.85 ± 97.22, p < 0.0001), whereas the improvement of PaO2/FiO2 (24.78 ± 35.03 vs. 97.17 ± 44.82, p < 0.001) was inconspicuous after systemic corticosteroid treatment for non-survival patients, compared with survival patients. Furthermore, the receiver operating characteristic (ROC) model revealed, when equivalent methylprednisolone usage was 146.5 mg/d, it had the best sensitivity and specificity to predict the death of ARDS. Survival analysis by Kaplan–Meier curves presented the higher 45-day mortality in high-dose corticosteroid treatment group (logrank test p < 0.0001). Multivariate Cox regression analyses demonstrated that serum IL-18 level, APACHE II score, D-dimer, and high-dose corticosteroid treatment were associated with the death of ARDS.Conclusion: Appropriate dose of corticosteroids may be beneficial for ARDS patients through improving the oxygenation and moderately inhibiting inflammatory response. The benefits and risks should be carefully weighed when using high-dose corticosteroid for ARDS.Trial registration: This work was registered in ClinicalTrials.gov. Name of the registry: Corticosteroid Treatment for Acute Respiratory Distress Syndrome. Trial registration number: NCT02819453. URL of trial registry record: https://register.clinicaltrials.gov.

Download Full-text