Effects Of Antenatal Steroid Treatment Research Articles

The Effects of Antenatal Steroid Treatment on Preterm Infants' Early Laboratory Analysis.

Objectives:We assessed the effects of antenatal steroid treatment on preterm laboratory analysis conducted in the first 24 hours of life.Methods:Medical records of inborn preterm infants whose gestational age was ≤32 weeks were retrospectively reviewed in this study. Preterm infants whose mothers received antenatal betamethasone treatment of either 12 mg or 24 mg and who did not were divided into two groups. Maternal and neonatal demographic characteristics, all preterm morbidities and mortality rates, early laboratory examinations were compared between the two groups.Results:Medical records of 603 infants between 2008 and 2013 were retrospectively reviewed. Data from 515 infants were analyzed. Three hundred and four infants (n=304) were in the antenatal steroid treatment (AST) group and 211 infants were in the group that did not receive the treatment. The incidence of preeclampsia and oligohydramnios was significantly higher in the AST group. Intubation in the delivery room rates decreased in the AST group. APGAR scores at five minutes were significantly higher in the AST group. White blood counts (WBC) significantly decreased, whereas the platelet counts were higher in the AST group. Serum C-reactive protein (CRP) and Interleukin-6 (IL-6) levels did not differ between groups.Conclusion:We did not demonstrate any relationship between inflammatory markers and antenatal steroid treatment in preterm infants.

The effect of antenatal steroid treatment on fetal autonomic heart rate regulation revealed by fetal magnetocardiography (fMCG)

Background Steroid administration to accelerate fetal lung maturation reduces neonatal morbidity and mortality in the case of preterm delivery. Behavioral observations suggest effects on fetal cardiovascular regulation. Aim We hypothesize that beat to beat heart rate variability (fHRV) derived from fetal magnetocardiography (fMCG) will reveal a direct, acute steroidal effect on fetal autonomic heart rate regulation. Subjects Eight patients between 29 and 34 weeks of gestation at risk for preterm birth who were treated with betamethasone (2 × 12 mg within 24 h). Study design Subjects were studied prior to the first and within 6 h after the second administration. Continuous fMCG was recorded with a 31-channel-SQUID biomagnetometer. Each dataset was processed by subtracting maternal cardiac artefacts and determining the time instants of the fetal heart beats. fHRV analysis was applied to periods of fetal quiescence of 4 min length. Outcome measures We compared fHRV prior versus post steroid administration. Results Steroid exposure reduced all parameters of overall fHRV significantly. The fHRV parameters representing short term variability remained unaffected. Mean fetal heart rate significantly decreased. The complexity of the heart rate patterns increased. Conclusion Our results suggest an acute shift in the symptaho-vagal balance of fetuses exposed to betamethasone in utero toward sympathetic suppression.

Antenatal corticosteroids and neonatal outcomes according to gestational age: a cohort study

ObjectiveTo see whether there was any difference in the effect of antenatal corticosteroids on neonatal outcomes according to different gestational ages at birth.MethodsThis was a prospective cohort study in a...

The effects of surfactant and antenatal corticosteroid treatment on the pulmonary pathology of preterm infants with respiratory distress syndrome

The aim of this study was to investigate the effects of antenatal steroid treatment and/or postnatal surfactant replacement therapy on the incidence and extent of selected histopathological findings. Seventy complete autopsies were reviewed, and only lung tissues were examined and graded. Infants were divided into treatment and control groups as follows: group 1: surfactant-treated infants ( n=15); group 2: infants whose mothers were given steroid treatment ( n=16); group 3: surfactant-treated infants whose mothers were given steroid treatment ( n=10). The control group included 29 patients not treated with surfactant and steroid. The overall incidence and severity of hyaline membrane and pulmonary hemorrhage were similar in each treatment group when compared to the control group. However, when the treatment groups were compared with each other, the incidence of severe hyaline membrane was more common in group 1 than in group 3. A significant reduction in severe hyaline membrane was associated with combined surfactant and antenatal steroid therapy. However, the cause for the similar incidence of selected histopathological findings in the treatment groups and the control group may be linked to oxygen toxicity due to insufficient antioxidant capacity in premature infants and barotrauma from mechanical ventilation.

The effect of antenatal steroid treatment for premature lung maturation on the fetal autonomous nervous system revealed by fetal magnetocardiography (fMCG)

Objective: Steroid administration prior to 34 gestational weeks to accelerate fetal lung maturation reduces neonatal morbidity and mortality in the case of preterm delivery. In the animal model, a reduction in beat-to-beat-variability of the fetal heart rate (fHRV) under steroid administration has been documented [1]. These observations are in accordance with the clinical experience of reduced biophysical activities of the human fetus. Aside from gestational age, fetal state is the major influencing factor on fHRV [2]. We test the hypothesis that both linear fHRV and complexity reflect the influence of betamethasone if the fetal state is considered.

Antenatal steroids and neonatal periventricular leukomalacia

Objective: To evaluate the effect of antenatal steroid treatment on the development of neonatal periventricular leukomalacia. Methods: This retrospective cohort study included 1161 neonates with gestational ages of 24–34 weeks and birth weights of 500–1750 g, divided into two groups on the basis of antenatal steroid treatment. Neonatal neurosonograms were done on days 3 and 7 of life and labeled normal or abnormal. The abnormal outcomes evaluated were periventricular leukomalacia or intraventricular hemorrhage, periventricular leukomalacia with intraventricular hemorrhage, and isolated periventricular leukomalacia. The group treated with antenatal steroids was compared with the untreated group for these outcomes. Results: Antenatal steroids were associated with significantly less periventricular leukomalacia or intraventricular hemorrhage (23% versus 31%, P = .005), periventricular leukomalacia with intraventricular hemorrhage (5% versus 11%, P = .001), and isolated periventricular leukomalacia (3% versus 7%, P = .009). Logistic regression analysis of antenatal steroid treatment, controlling for confounding maternal and neonatal characteristics, indicated that neonates treated with antenatal steroids had a 56% lower likelihood of periventricular leukomalacia with intraventricular hemorrhage (adjusted odds ratio [OR] 0.44, 95% confidence interval [CI] 0.25, 0.77) and a 58% lower likelihood of isolated periventricular leukomalacia (adjusted OR 0.42, 95% CI 0.20, 0.88). Conclusion: Antenatal steroid treatment was associated with over 50% reduction in the incidence of periventricular leukomalacia in preterm neonates. Increased use of antenatal steroid therapy might improve long-term neonatal neurologic outcomes.

Evidence from multicenter neworks on the current use and effectiveness of antenatal corticosteroids in low birth weight infants

Corticosteroid treatment of pregnant women at risk for preterm delivery enhances fetal lung maturity and improves neonatal outcomes.’ Despite convincing evidence of these effects, a consensus has not been reached about the indications for antenatal steroids, and the frequency with which they are used remains low in some countries, including the United States. In response to this situation, the National Institutes of Health (NIH) convened a Consensus Development Conference on the Effects of Corticosteroids for Fetal Maturation on Perinatal Outcomes.’ The following reports were prepared at the request of the panel; they describe the effects of antenatal steroid treatment on neonatal outcome from five current observational databases: those of the National Institute of Child Health and Development (NICHD) Neonatal Research Network, the Vermont-Oxford Trials Network, Ross Laboratories, and Burroughs Wellcome (BW) Co. The purpose of this article is to present an overview of the findings of these five large databases.