Lungenreifeinduktion mit Glukokortikoiden - einmalige oder wiederholte Applikation?

Abstract

The discussion on the application of multiple versus single courses of antenatal corticosteroids (ANC) for the prevention of respiratory distress syndrome (RDS) in newborns is still controversial. Since the benefits of ANC have been shown to be most significant within 7 to 10 days after treatment, many obstetricians tend to treat women with repeated courses of ANC if the risk of premature delivery persists. However, data from animal as well as from clinical studies suggest detrimental effects of multiple courses of ANC: an increase of neonatal mortality, low birth weight, retardation of mental, and psychomotoric development, an increase in infectious morbidity of the mother and the newborn, alterations of intra-uterine programming by modification of the hypothalamic-pituitary-adrenal axis with the consequence of an increased rate of diabetes and hypertension in later life. However, a detailed review of the literature fails to prove a causal relationship between multiple courses of ANC and the complications mentioned above. Conversely, only gradual decreases in the severity of RDS do not justify routine application of repeated courses of ANC. Until publication of the results of larger prospective randomised controlled trials, each pregnant woman at significant risk for premature delivery (24-34 weeks of gestation) should receive a single course of ANC (e.g. betamethasone, 2 x 12 mg in a 24-hour interval). Based on the data pub-lished, a second course ofANC can be considered as efficient and harmless.