antenatal steroids
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2021 ◽  
Vol 10 (4) ◽  
pp. 206-209
Author(s):  
Saniya Naheed ◽  
Sajida Guftaar ◽  
Dure Shahwar ◽  
Seema Gul ◽  
Mahwash Jamil ◽  
...  

OBJECTIVE:To determine the frequency of transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM) in preterm pregnant women receiving antenatal steroids. METHODOLOGY:This descriptive cross-sectional study was carried out in Maternal and Child Health Center unit 1 (MCH-1) at Pakistan Institute of Medical Sciences Islamabad Pakistan from January 2017 till August 2017. A total of 365 pregnant women presenting to emergency and outpatient department with preterm labor (alive morphologically normal babies), with preterm premature rupture of membranes (PPROM) and other conditions which require early delivery including preeclampsia, IUGR requiring preterm delivery, severe oligohydramnios, antepartum hemorrhage(APH), women receiving two doses dexamethasone and all those with BSR>126mg/dl were included in the study. Multiple pregnancies, advanced preterm labor (cervix > 5cm dilated), gestational diabetes mellitus (GDM) or type I/II diabetes mellitus (DM), chorioamnionitis and taking any medication that affects glucose metabolism were excluded from the study. After ethical approval, informed consent was taken from study participants. Blood sugar levels before the commencement of 1st dose of dexamethasone were noted. Blood sugar profile (fasting, 2 hours after lunch, 2 hours after dinner) were carried out. 2nd dose of dexamethasone was given after 12 hours of 1st dose. Profile was carried out till euglycemia or 5 days if sugars remain deranged.  Patients having deranged levels for greater than 5 days were advised 75 g oral glucose tolerance test(OGTT) and labelled as having impaired glucose tolerance or gestational diabetes mellitus. RESULTS: In our study, 57.57%(n=213) were between 18-30 years, 42.43%(n=157) were between 31-40 years of age, mean age was calculated as 28.92+5.54 while mean gestational age was 31.19+1.92 weeks. Frequency of transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM) in preterm pregnant women receiving antenatal steroids revealed 62.16%(n=230) had transient hyperglycemia, 9.46%(n=35) had impaired glucose tolerance, 2.16%(n=8) had gestational diabetes and 26.22%(n=97) had no blood glucose abnormality.   CONCLUSION: We concluded that the frequency of abnormal glucose levels increases in preterm pregnant women receiving antenatal steroids. Therefore, single blood sugar level done routinely before dexamethasone therapy are insufficient to judge the glucose metabolic status and should be closely monitored during the use of antenatal corticosteroids. KEYWORDS: Preterm delivery, antenatal steroids, transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM)


2021 ◽  
pp. 8-14
Author(s):  
P. Swathi ◽  
K. Radhikajyothi

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.


2021 ◽  
pp. 097321792110597
Author(s):  
Jennifer Peterson ◽  
Mia Kahvo ◽  
Ramiyya Tharumakunarajah ◽  
Nabiah Malik ◽  
Ranganath Ranganna

Background: Improvements in extreme preterm infant outcomes have led to an increasing recognition of the importance of antenatal optimization and delivery room (DR) management strategies for these infants. Methods: Retrospective cohort evaluation of every infant born at 22+0 to 25+6 weeks gestation in St Mary’s tertiary NICU between 2008 and 2018. Aiming to evaluate utilization of chest compressions and resuscitation medications during DR-resuscitation of extremely premature infants. Results: This study found that 90% of infants 22+0 to 22+6 weeks did not receive antenatal steroids. Whereas, for infants born between 23+0 and 23+6 weeks gestation, 75% did receive antenatal steroids. This difference is significant ( P value = .00006). This study shows there is a predisposition to not provide DR-chest compressions (DR-CC) and/or adrenaline (DR-CC+/−A) to extremely preterm For infants. Infants that received DR-CC, there was no statistically significant increase in death and no clear association with poorer long-term outcomes in survivors. Conclusions: Marked differences in provision of perinatal care were found dependent on gestational age. If infants are inadequately prepared for delivery and resuscitative measures are not fully utilized, it cannot be clear whether subsequently increased rates of death in the lower gestational age groups are solely due to gestational age or are influenced by the lack of preparative management.


Author(s):  
Heather M. Weydig ◽  
Charles R. Rosenfeld ◽  
Myra H. Wyckoff ◽  
Mambarambath A. Jaleel ◽  
Patti J. Burchfield ◽  
...  

Author(s):  
Buranee Yangthara ◽  
Visanu Kittiarpornpon ◽  
Pitiporn Siripattanapipong ◽  
Walaiporn Bowornkitiwong ◽  
Ratchada Kitsommart ◽  
...  

Background: Before the advent of antenatal steroids, early non-invasive respiratory support (NIV) and intratracheal surfactant, antenatal terbutaline was also used to improve lung compliance and reduce the incidence of respiratory distress syndrome (RDS). Objectives: To study the association between antenatal terbutaline and endotracheal intubation (ET) within the first 24 hours of life, RDS, bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) in infants with gestational age (GA) of < 32 weeks. And to study the association between antenatal terbutaline, and ET or NIV within the first 24 hours of life, and RDS in infants with GA of 32 to 36 weeks. Method: A retrospective medical record review of preterm infants delivered at a single tertiary care center from October 2016 to December 2020. Multivariable logistic regression was used to explore the association between antenatal terbutaline and neonatal respiratory support. Result: 1,794 infants were included, 234 (13.0%) had GA < 32 weeks and 1,560 (86.9%) had GA 32 to 36 weeks. Antenatal terbutaline, corticosteroid, or both agents were administered in 561 (31.3%), 1,461 (81.4%), and 555 (30.9%), respectively. Antenatal terbutaline was significantly associated with a reduction in ET (adjusted odds ratio (aOR) = 0.40, 95% confident interval (CI) 0.19 to 0.82, p = 0.012) in infants of GA < 32 weeks, but not in infants with GA 32 to 36 weeks. Antenatal terbutaline was not associated with RDS or BPD, but was significantly associated with a reduction in grade III-IV IVH (aOR 0.11, CI 0.01 to 0.98; p = 0.048), in infants of GA < 32 weeks. Conclusion: In a state-of-the-art neonatal care setting, antenatal terbutaline was associated with a reduction in ET during the first 24 hours in infants of GA < 32 weeks. The use of antenatal terbutaline to improve acute neonatal respiratory outcomes merits reconsideration.


Author(s):  
Rasha T Hamza ◽  
Amira I Hamed ◽  
Basma B B Hassan ◽  
Wafaa O Ahmed

Purpose: The study examined the effect of antenatal steroids on thyroid functions in late preterm infants on the third to the seventh day of life. Patients and Methods: A comparative Cross-Sectional study was conducted on 75 neonates admitted to NICU in the first week of life. They were divided according to exposure to antenatal steroids into three groups. First group: exposed to complete course of ANS. Second group: exposed to partial course of ANS. The third group: not exposed to ANS. Serum samples were obtained from selected cases free T3, Free T4, and TSH levels in the third day of life, compared to the cut of levels currently available (the TSH reference range is (1.7 to 9.1 mU per L), T4 should be greater than( 10 mcg per dL). Using Eleusis and Cubase analyzers kits (Roche Diagnostics, Indianapolis, IN, USA) by ELISA (enzyme-linked immune sorbent assay) technique. Results: The study showed that there were significantly higher serum T4 levels in group 1 that was exposed to a complete course compared to group 2 (partial course) and 3 (Third group). There were no significant differences in serum TSH, T3 levels between groups. The current study found a decreased incidence of the ROP, NEC and BPD among group 1 as compared to the other two groups although was non statistically significant. In addition, the complete course of ANS had delayed the date of delivery (P=0.04) as compared to the partial course in the current study. Conclusion: Antenatal corticosteroids can influence thyroid function in late preterm infants as serum T4 was significantly higher in infants exposed to complete course compared to those who were exposed to partial course or did not receive antenatal corticosteroids.


2021 ◽  
Author(s):  
Olga Kochukhova ◽  
Ylva Fredriksson Kaul ◽  
Martin Johansson ◽  
Cecilia Montgomery ◽  
Gerd Holmström ◽  
...  

2021 ◽  
Vol 9 ◽  
Author(s):  
Theresa Thiess ◽  
Tina Lauer ◽  
Annika Woesler ◽  
Janine Neusius ◽  
Sandro Stehle ◽  
...  

Background: Bronchopulmonary dysplasia (BPD) has multifactorial origins and is characterized by distorted physiological lung development. The impact of nutrition on the incidence of BPD is less studied so far.Methods: A retrospective single center analysis was performed on n = 207 preterm infants &lt;1,000 g and &lt;32 weeks of gestation without severe gastrointestinal complications to assess the impact of variations in nutritional supply during the first 2 weeks of life on the pulmonary outcome. Infants were grouped into no/mild and moderate/severe BPD to separate minor and major limitations in lung function.Results: After risk adjustment for gestational age, birth weight, sex, multiples, and antenatal steroids, a reduced total caloric intake and carbohydrate supply as the dominant energy source during the first 2 weeks of life prevailed statistically significant in infants developing moderate/severe BPD (p &lt; 0.05). Enteral nutritional supply was increased at a slower rate with prolonged need for parenteral nutrition in the moderate/severe BPD group while breast milk provision and objective criteria of feeding intolerance were equally distributed in both groups.Conclusion: Early high caloric intake is correlated with a better pulmonary outcome in preterm infants &lt;1,000 g. Our results are in line with the known strong impact of nutrient supply on somatic growth and psychomotor development. Our data encourage paying special attention to further decipher the ideal nutritional requirements for unrestricted lung development and promoting progressive enteral nutrition in the absence of objective criteria of feeding intolerance.


2021 ◽  
pp. 097321792110483
Author(s):  
Tanushree Sahoo ◽  
Abhishek Somasekhara Aradhya ◽  
Kanya Mukhopadhyay

Antenatal steroids (ANS) are proven strategies to maximize outcomes of premature neonates without any major maternal side effects. Their use results in decreased incidence of neonatal mortality and major morbidities (respiratory distress syndrome, early onset sepsis, necrotizing enterocolitis, and intraventricular hemorrhage). However, due to concerns of long-term adverse effect (early onset hypertension and poor neurological outcome), a close follow-up is required. Similarly, due to lack of long-term follow-up data and potential risk of hypoglycemia, a cautious use is recommended in late preterms and elective cesareans. There is currently no consensus regarding preferential use of one ANS over the other. The current review therefore tried to address these issues for use of ANS in Indian prospective in light of recent emerging evidence. Due to better safety profile, lesser side effects, lower cost, and easy storage, we recommend dexamethasone as a steroid of choice for antenatal prophylaxis.


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