Efficacy and Safety of Corticosteroids’ Administration for Pulmonary Immaturity in Anticipated Preterm Delivery

2020 ◽  
Vol 26 ◽  
Author(s):  
Themistoklis Dagklis ◽  
Ioannis Tsakiridis ◽  
Georgios Papazisis ◽  
Apostolos Athanasiadis
Keyword(s):  
Preterm Delivery ◽  
Neonatal Morbidity ◽  
Fetal Lung ◽  
Respiratory Morbidity ◽  
Efficacy And Safety ◽  
Antenatal Corticosteroids ◽  
Lung Maturation ◽  
Early Neonatal Mortality ◽  
Elective Cesarean ◽  
Fetal Lung Maturation

: Preterm delivery represents the major cause of neonatal morbidity and mortality. Respiratory morbidity is the primary cause of early neonatal mortality and disability. The administration of antenatal corticosteroids, in cases of imminent preterm delivery, can enhance fetal lung maturation and reduce the incidence of respiratory distress syndrome, leading to improved neonatal outcomes. Hence, for those cases, a single course of antenatal corticosteroids from 24 up to 34 gestational weeks should be offered. Betamethasone and dexamethasone are the most widely used drugs, with similar effectiveness and a recommended dosage of 24mg in divided doses, over a 24-hour period. However, there is an ongoing debate regarding the gestational age of administration. Some obstetric societies recommend their administration even at 22 weeks of gestation. Conflicting is also their usefulness in late preterm cases (between 34 and 37 weeks) or in cases of elective cesarean delivery at term. The use of repeated courses of corticosteroids may be considered in specific cases, however, concerns on the long-term outcomes of repeated courses beyond 34 gestational weeks have been raised. The scope of this narrative review was to synthesize available evidence on efficacy and safety of corticosteroids administration during the antenatal period for pulmonary immaturity in cases of anticipated preterm delivery.

The risk of neonatal respiratory morbidity according to the etiology of late preterm delivery

2017 ◽  
Vol 45 (1) ◽  
Author(s):  
Sung Ae Kim ◽  
Seung Mi Lee ◽  
Byoung Jae Kim ◽  
Chan-Wook Park ◽  
Joong Shin Park ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Preterm Delivery ◽  
Fetal Lung ◽  
Late Preterm ◽  
Respiratory Morbidity ◽  
Preterm Neonates ◽  
Lung Maturation ◽  
Study Population ◽  
Fetal Lung Maturation ◽  
Fetal Compromise

AbstractObjective:The risk of neonatal respiratory morbidity between indicated deliveries vs. spontaneous deliveries has not been consistent in previous studies, in spite of the traditional belief that chronic intrauterine stress might have protective effect on fetal lung maturation. We hypothesized that the heterogeneous etiology of indicated preterm delivery may obscure the relationship between the etiologies of preterm birth and neonatal respiratory morbidity. To address this issue, we divided the indicated preterm birth (PTB) into medically-indicated (without fetal compromise) PTB and maternal/fetal-indicated PTB, and compared the neonatal respiratory morbidity according to the etiology of late PTB.Study design:Neonatal respiratory morbidities were examined in neonates who were delivered between 34+0 and 36+6 weeks of gestation according to the etiology of PTB: 1) medically-indicated PTB (but without fetal compromise), 2) maternal/fetal-indicated PTB, or 3) spontaneous PTB such as preterm labor or preterm premature rupture of membranes.Results:A total of 710 late preterm neonates were included in the study population, including 31 cases of medically-indicated PTB, 202 cases of maternal/fetal-indicated PTB, and 477 cases of spontaneous PTB. The rate of composite respiratory morbidity in cases of medically-indicated PTB is higher than both maternal/fetal-indicated PTB and spontaneous PTB (19% in medically-indicated PTB, 6% in maternal/fetal-indicated PTB, and 7% in spontaneous PTB). This difference between medically-indicated PTB and maternal/fetal-indicated PTB remained significant after adjustment for confounding variables.Conclusion:The medically-indicated PTB is associated with highest risk of neonatal respiratory morbidity in late PTB.

scholarly journals Antenatal corticosteroids for fetal lung maturation in threatened preterm delivery: indications and administration

2012 ◽  
Vol 286 (2) ◽  
pp. 277-281 ◽  
Author(s):  
Daniel Surbek ◽  
Gero Drack ◽  
Olivier Irion ◽  
Matthias Nelle ◽  
Dorothy Huang ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Fetal Lung ◽  
Antenatal Corticosteroids ◽  
Lung Maturation ◽  
Fetal Lung Maturation

scholarly journals Antenatal corticosteroids: a reappraisal of the drug formulation and dose

2020 ◽  
Author(s):  
Alan H. Jobe ◽  
Matthew Kemp ◽  
Augusto Schmidt ◽  
Tsukasa Takahashi ◽  
John Newnham ◽  
...  
Keyword(s):  
Perinatal Care ◽  
Fetal Lung ◽  
The United States ◽  
Drug Formulation ◽  
List Type ◽  
Continuous Exposure ◽  
Fetal Exposure ◽  
Antenatal Corticosteroids ◽  
Lung Maturation ◽  
Fetal Lung Maturation

Abstract We review the history of antenatal corticosteroid therapy (ACS) and present recent experimental data to demonstrate that this, one of the pillars of perinatal care, has been inadequately evaluated to minimize fetal exposure to these powerful medications. There have been concerns since 1972 that fetal exposures to ACS convey risk. However, this developmental modulator, with its multiple widespread biologic effects, has not been evaluated for drug choice, dose, or duration of treatment, despite over 30 randomized trials. The treatment used in the United States is two intramuscular doses of a mixture of 6 mg betamethasone phosphate (Beta P) and 6 mg betamethasone acetate (Beta Ac). To optimize outcomes with ACS, the goal should be to minimize fetal drug exposure. We have determined that the minimum exposure needed for fetal lung maturation in sheep, monkeys, and humans (based on published cord blood corticosteroid concentrations) is about 1 ng/ml for a 48-h continuous exposure, far lower than the concentration reached by the current dosing. Because the slowly released Beta Ac results in prolonged fetal exposure, a drug containing Beta Ac is not ideal for ACS use. Impact Using sheep and monkey models, we have defined the minimum corticosteroid exposure for a fetal lung maturation. These results should generate new clinical trials of antenatal corticosteroids (ACS) at much lower fetal exposures to ACS, possibly given orally, with fewer risks for the fetus.

scholarly journals Antenatal steroids for fetal lung maturity: Time to target more frequent doses to fewer women?

2015 ◽  
Vol 8 (4) ◽  
pp. 172-176 ◽  
Author(s):  
Carolyn I Freeman ◽  
Natasha L Hezelgrave ◽  
Andrew H Shennan
Keyword(s):  
High Risk ◽  
Day Treatment ◽  
Fetal Lung ◽  
Optimal Timing ◽  
Antenatal Corticosteroids ◽  
Lung Maturation ◽  
Targeting Therapy ◽  
Antenatal Steroids ◽  
Maximum Benefit ◽  
Fetal Lung Maturation

Antenatal corticosteroids for fetal lung maturation have become mainstay treatment in women thought to be at high-risk of premature birth. To ensure treatment efficacy before delivery, the current practice is to administer steroids early to a woman considered at risk; however, neonatal benefit is lost after the seven-day treatment-to-delivery window. Over half of women who deliver before 34 weeks’ gestation do not receive antenatal corticosteroids within this timeframe, but many still deliver prematurely; however, clinicians are reluctant to administer repeated courses of steroids due to concerns, among others, of impaired fetal growth. However, evidence is mounting regarding the optimal timing for steroids, including substantive benefits close to delivery, and the benefits of repeated courses if delivery has not occurred. Better targeted treatment is required to allow for maximum benefit; reducing unnecessary treatment in low-risk women, while targeting therapy in the high-risk cohort and offering repeat courses if the seven-day window is exceeded. Novel tools to aid prediction may help implement this strategy.

Sign in / Sign up

Export Citation Format

Share Document