Variations in antenatal corticosteroid therapy: A persistent problem despite 30 years of evidence
Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada Obstetrics and Gynecology
(Impact Factor: 5.18).
04/2002; 99(3):401-8. DOI: 10.1016/S0029-7844(01)01732-X
To document current use of antenatal corticosteroid therapy in a large cohort of Canadian preterm infants admitted to neonatal intensive care units, and to assess the impact of variations in use on neonatal outcomes.
The study subjects included 11,440 infants less than 38 weeks' gestation who were admitted to 17 Canadian Neonatal Network intensive care units from January 1996 to October 1997. Data analyses were conducted separately for infants less than 24 weeks' gestation, 24-34 weeks' gestation, and over 34 weeks' gestation. Logistic regression analysis was used to model the examined relationships, controlling for patient characteristics.
The incidence of antenatal corticosteroid treatment was 42% for infants less than 24 weeks' gestation, 59% for infants 24-34 weeks' gestation, and 10% for infants over 34 weeks' gestation. Antenatal corticosteroid treatment was associated with reduced risk for neonatal mortality and respiratory distress syndrome, but not for infants over 34 weeks' gestation. Significant institutional variations in antenatal corticosteroid use were present among both inborn and outborn infants. Increased antenatal corticosteroid treatment for infants 24-34 weeks' gestation can potentially reduce the number of neonatal deaths by 41 cases (10%) and respiratory distress syndrome by 90 cases (3%) among participating hospitals.
Wide institutional differences persist in the incidence of antenatal corticosteroid treatment for women expected to give birth preterm. Increased use of antenatal corticosteroids for preterm deliveries can reduce neonatal mortality in Canada by up to 10%.
Available from: Krzysztof Czajkowski
- "The smaller benefits attributed to incomplete steroid courses could be due to inadequate doses and shorter durations of foetal exposure. Chien et al. presented data concerning antenatal steroid administration to 11 440 infants in Canada. Only 30% of children completed the antenatal steroid course. "
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ABSTRACT: The beneficial effects of antenatal steroids in women at risk of preterm birth are evident. A dose of 24 mg appears sufficient, but there are insufficient data to recommend betamethasone or dexamethasone, a single steroid dose, the optimal interval between doses and repeated courses, the gestational age at which treatment is beneficial and the long-term effects of steroid treatment. This review addresses these aspects of antenatal steroid treatment.
Although the 12-h and 24-h dosing intervals are equivalent with respect to prevention of respiratory distress syndrome, the former enables the completion of treatment in 50% more neonates delivered prematurely. Reducing the single steroid dose in patients at risk for premature birth reduces the associated maternal side effects. An inverse relationship has been demonstrated between the number of corticosteroid courses and foetal growth. The reduced size of exposed foetuses has been attributed to birth at earlier gestational ages and decreased foetal growth. Evidence suggests that antenatal exposure to synthetic glucocorticoids in term-born children has long-lasting effects, which may have important implications in the recommendation of steroids before elective caesarean at term.
The short-term and long-term effects of the dosage regimen on the pregnant mother and foetus remain unclear.
Available from: Enrico Lopriore
- "After the results of the randomized trial of Liggins and Howie in 1972  became available, the introduction and widespread use of antenatal corticosteroids (CST) in severely preterm fetuses resulted in a drastic decrease of neonatal morbidity and mortality  . "
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ABSTRACT: Antenatal corticosteroid administration to premature, growth restricted fetuses may not be beneficial and even have adverse effects on neonatal outcome.
To determine if preterm growth restricted fetuses benefit from antenatal corticosteroids.
Retrospective cohort study.
All singleton pregnancies with growth restricted fetuses delivered at our department before 34 weeks' gestation or weighing less than 1500 g, between January 2001 and December 2005, were retrospectively reviewed. Neonatal outcome was compared between growth restricted fetuses (defined as abnormal flow patterns in umbilical and middle cerebral arteries) that received antenatal CST (CST group) and those who did not receive antenatal CST (no CST group). The administration of CST appeared to be quasi randomized.
A total of 88 pregnancies fulfilled the inclusion criteria (CST group, n=54; no CST group, n=34). The incidence of neonatal respiratory distress syndrome in the CST and no CST group was 42% (22/54) and 50% (17/34), respectively (p=0.44). Neonatal mortality in the CST and no CST group was 9% (5/54) and 12% (4/34), respectively (p=0.73). The prevalence of adverse neonatal outcome (neonatal mortality, major neonatal morbidity or severe cerebral lesions) in the CST and no CST group was 28% (15/54) versus 24% (8/34), (p=0.62).
Administration of CST to growth restricted preterm fetuses does not appear to be beneficial with respect to short term neonatal outcome.
Available from: Arne Ohlsson
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