Multiple Courses Of Antenatal Steroids Research Articles

Abnormal Newborn Screen During a Pandemic.

Abnormal Newborn Screen During a Pandemic.

Safety of single vs multiple courses of antenatal steroids

Safety of single vs multiple courses of antenatal steroids

Editor’s Choice

Editor’s Choice

Single and multiple courses of antenatal steroids regulate connexin 36 abundance in the ovine fetal brain

Connexin 36 (Cx 36) forms gap junctions (GJ). GJ facilitate intercellular communication and are important in neuronal differentiation during development. Cx 36 is the main GJ between neurons, increases during rodent development and is up regulated by dexamethasone (DEX) in pancreatic islets. The effects of steroids on GJ proteins have not been examined in fetal brain. We examined the effects of single and multiple courses of DEX on Cx 36 abundance in the cerebral cortex (CC), cerebellum (CL) and cervical spinal cord (SP), and differences in Cx 36 protein abundance among fetal brain regions. Ovine fetuses at 70% of gestation were examined after a single course of four 6 mg DEX or placebo (PL) injections were given every 12 h for 48 h to the ewes, or the same DEX or PL given course once a wk for 5 wks. Regional brain tissue was frozen after the last DEX or PL dose. Cx 36 protein expression was determined by Western immunoblot. A single course of DEX increased (P < 0.05) Cx 36 protein abundance compared with PL in the CC and SP, and multiple courses increased Cx 36 in SP, but not in CC or CL. Cx 36 was higher in SP than CL. Maternal DEX treatment regulates Cx 36 proteins in vivo in the fetal CC and SP, but not in CL. Different DEX regimens regulate Cx 36 protein abundance in specific brain regions. The greater abundance of Cx 36 protein in SP than CL may suggest the presence of more functional channels in SP in the premature fetal brain.

Multiple courses of antenatal steroids "not recommended"

Multiple courses of antenatal steroids "not recommended"

Review: multiple doses of antenatal corticosteroids prevent preterm neonatal respiratory disease more than a single dose

ED FROM Crowther CA, Harding JE. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for preventing neonatal respiratory disease. Cochrane Database Syst Rev 2007;(3):CD003935. Correspondence to:...

Multiple courses of antenatal steroids

The benefits and risks of multiple courses of antenatal steroids (ANS) are still unresolved issues. This was a prospective cohort study in a level III neonatal unit. Preterm babies < or = 35 wk gestation were included. Malformations, chronic maternal steroid intake, exchange transfusions prior to cortisol sampling and incomplete ANS courses were exclusion criteria. Subjects were classified into: No course (Group 0), 1 course (group 1), 2 courses (Group 2), > 2 courses (Group 3) of antenatal dexamethasone. The key outcome was adrenal function assessed by basal and post-ACTH cortisol on day 3. Other outcomes were neonatal morbidity, mortality, growth parameters at birth, long term growth and neuro-development. Of 210 eligible babies, 124 were enrolled. 38, 51, 10 and 25 babies belonged to groups 0, 1, 2 and 3 respectively. Basal and post-ACTH serum cortisol did not show any significant difference between groups (p=0.5 and p=0.9 respectively). Incidence of severe HMD requiring ventilation was significantly lower (p=0.02) in multiple course group (combined groups 2 and 3) compared to single course group. There were no differences in other neonatal morbidity, birth OFC and weight between single and multiple ANS groups. Follow up data at a mean age of 22 mth was available in 59 subjects (69%) belonging to groups 1-3. No differences were noted in the proportion of patients with abnormal neurological examination (p=0.1), abnormal PDI (p=0.9), abnormal MDI (p=0.9) and physical growth between multiple and single course groups. Multiple courses of antenatal dexamethasone resulted in a significant decrease in severe forms of RDS and they did not cause adrenal suppression, decreased growth or impaired neuro-development.

Newborn anthropometric measurements in twin pregnancies exposed to multiple courses of antenatal steroids

Newborn anthropometric measurements in twin pregnancies exposed to multiple courses of antenatal steroids

Neonatal Morbidity and Growth in Very Low Birth-Weight Infants after Multiple Courses of Antenatal Steroids

To evaluate the neonatal morbidity and the growth in very low birth-weight (VLBW) infants after exposure to multiple courses of antenatal steroids. A total of 319 VLBW infants were placed in one of the two groups based on exposure to antenatal steroids: Group 1: less than two complete courses; Group 2: two complete courses or more. Anthropometric measurements at birth and discharge and neonatal morbidity were recorded. Composite morbidity was defined as presence of any of the following: death, chronic lung disease, major intraventricular hemorrhage and periventricular leukomalacia. The composite morbidity was not significantly different between the two groups (p=0.26). A significantly higher percentage of infants born after multiple courses of antenatal steroids had head circumference below 10th percentile at discharge (23 vs 9%, adjusted OR, 3.25, (95% CI, 1.4, 7.3); p=0.015). Multiple courses of antenatal steroids may predispose VLBW infants to impairment of postnatal somatic growth without providing any additional benefit for immediate neonatal outcome.

Interval head growth for infants exposed to multiple doses of antenatal steroids

ANTENATAL STEROIDS JULIE SLOAN, THADDEUS WATERS, SEAN DALY, MARGARET SHERIDAN-PEREIRA, ROBERT GORMAN, ANTHONY SCISCIONE, RONALD WAPNER, Coombe Women’s Hospital, Dublin, Ireland, Ireland, Drexel University, Obstetrics and Gynecology, Philadelphia, Pennsylvania, Coombe Women’s Hospital, Dublin, Ireland, Ireland, Drexel University College of Medicine, Obstetrics and Gynecology, Philadelphia, Pennsylvania OBJECTIVE: Multiple doses of antenatal steroids have been associated with smaller head circumferences at birth. No study has addressed the long-term head growth of children exposed to antenatal steroids. We sought to determine the long-term effect of multiple courses of antenatal corticosteroids on head circumference. STUDY DESIGN: This is a retrospective case-cohort study performed at a tertiary care hospital. Our obstetrical database identified all singleton pregnancies >24 weeks gestation at risk for preterm birth between 1995-99. Data collected included maternal demographic characteristics, neonatal outcomes, number of steroid doses, gestational age at administration of steroids, gestational age at delivery, neonatal anthropometric measurements and serial anthropometric measurements. A full course of steroid therapy was defined as two doses of dexamethasone 12mg over 48 hours. An attending physician determined weekly steroid doses. We compared the neonates of mothers who received dexamethasone to neonates who were not exposed. Number of steroid courses and follow-up head circumferences were evaluated. Mantel-Haenszel test was used where appropriate. RESULTS: A total of 625 pregnancies were eligible for analysis with 469 infants (75.1%) having at least one follow-up exam for head circumference (HC). All 469 infants had a documented head circumference between 30 days of age and 3 years of age. Steroid dosing and HC at!10th percentile is presented in the table. Infants exposed to antenatal steroids were not more likely to have head circumferences below the 10th percentile than those that were unexposed (OR = 0.20 95% CI 0.007-5.4528). CONCLUSION: Infants exposed to multiple courses of antenatal steroids do not appear to have a higher risk of HC !10th percentile on interval evaluation.

Current controversies surrounding the use of repeated courses of antenatal steroids.

The use of a single dose of antenatal steroids to facilitate fetal lung maturation in the expectant management of threatened preterm birth has significantly improved the mortality and morbidity of premature infants worldwide. In some settings, the evidence for this practice has been extrapolated with self-reports of up to 6 repeated courses during the antepartum period. Concerns about the use of repeated antenatal courses prompted the National Institutes of Health (NIH) to publish a consensus statement (2000) that reaffirmed the safety and efficacy of a single course of antenatal steroids, but emphasized that there are no data to support the safety and efficacy of repeated courses. The statement cautions against the use of multiple courses outside of research protocols. Despite these recommendations, wide variations in clinical practice continue to exist. There are growing concerns about the potential deleterious effects of steroid exposure on the developing human brain. It is plausible, although not proven, that negative neurodevelopmental impact may occur, or be compounded by multiple antenatal or combined antenatal and postnatal steroid exposures. This article provides a review of the evidence to support appropriate steroid use. The physiology and pharmacology of both endogenous and exogenous steroids are outlined to enhance the clinician's understanding of these potent agents. Recommendations for targeted clinical evaluation and short- and long-term follow-up of steroid exposed infants are provided. A clear understanding of the known and potential risks and benefits of single and multiple courses of antenatal steroids is essential to prompt a critical re-examination of the safety and efficacy of repeated steroid exposure in the neonate.

Multiple Courses of Antenatal Steroids

In Brief OBJECTIVE To review the existing literature regarding the effect of multiple courses of antenatal corticosteroids in reducing the occurrence of complications arising because of lung immaturity. DATA SOURCES A systematic review of the English-language literature was conducted using a computerized database. We searched the English-language human and animal literature in MEDLINE and PubMed (National Library of Medicine, Bethesda, MD), as well as abstracts from recent meetings of the Society for Gynecologic Investigation and the Society for Maternal-Fetal Medicine. The search terms used were antenatal steroids, prenatal steroids, and respiratory distress syndrome. STUDY SELECTION We screened 2472 abstracts and found 280 relevant articles, which we independently reviewed. Only prospective well-designed animal studies were included. In humans, no well-designed randomized controlled trials (RCTs) were identified. Data that specifically addressed the issue of beneficial and adverse outcome of multiple courses of antenatal corticosteroids were included. TABULATION, INTEGRATION, AND RESULTS Twelve studies and three abstracts concerning animal models were included. These suggest multiple adverse consequences including decrease in birth and lung weights and brain growth restriction. In humans, 14 publications and five abstracts, mostly in the form of retrospective studies, although methodologicaly lacking, were included. Possible beneficial effects include lower rates of respiratory distress syndrome and a decrease in oxygen use, whereas adverse outcomes embody reduction in birth head circumference, birth weights, and increased neonatal and maternal infection rates. CONCLUSION To date, there are no well-designed RCTs in humans that support the advantages of multiple courses over a single course of antenatal corticosteroids. An increasing body of evidence raises the concern of adverse consequences from the use of repeated courses. While awaiting results from RCTs in progress, we recommend that a single course of antenatal corticosteroids be given to all women at risk for preterm birth at 24–34 weeks' gestation. Repeated doses of antenatal steroids for fetal lung maturation may have multiple adverse consequences with no clear benefit over a single course.

The effect of multiple courses of antenatal steroids on neonatal infection

Objective: The objective of this study was to determine if multiple courses of antenatal steroids in women with preterm premature rupture of membranes (PPROM) are associated with an increased incidence of neonatal sepsis.Methods: 206 women with PPROM between 22–34 weeks of gestation inclusive who did not deliver within 24 hours of admission were followed prospectively. Management included intravenous antibiotics, weekly betamethasone, daily fetal nonstress testing and twice weekly biophysical profiles. Neonatal complications including sepsis were extracted from the medical record at discharge. Fisher’s exact test was used to compare the incidence of neonatal sepsis among patients with single versus multiple courses of steroids. Significance was defined as P <0.05.Results: Ten (4.8%) neonates had the diagnosis of sepsis. The median number of steroid courses was 2 (range 1–11). No significant difference was noted between the incidence of sepsis when one course of steroids was compared with two or multiple courses.Conclusion: In our population, multiple courses of steroids do not increase the incidence of neonatal sepsis in patients with PPROM. Steroid Courses12345≥6Neonatal sepsis, n (%)6 (7.1)2 (2.7)2 (6.9)000Total (N = 206)8573291072

Effectiveness of multidose antenatal steroids

Objective: To compare effectiveness between single and multiple courses of antenatal steroids in preterm births and determine adverse effects attributable to multiple courses. Methods: We studied retrospectively the neonatal outcomes of infants who weighed 1750 g or less at birth between January 1990 and December 1997. Infants exposed to a single course were compared with those exposed to two or more courses of antenatal steroids, with respect to various perinatal outcome variables. Results: Ninety-three neonates were exposed to two or more courses of antenatal steroids and 261 neonates had been given single courses. The mean (± standard deviation) gestational age (29.6 ± 2.8 weeks compared with 28.7 ± 2.7 weeks; P = .007) and birth weight (1252 ± 321 g compared with 1159 ± 339 g; P = .013) were significantly higher among neonates exposed to multiple courses. There were no significant differences between groups in perinatal outcomes; however, those exposed to multiple courses had a significantly lower rate of respiratory distress syndrome (RDS) (17 [18%] compared with 107 [41%]; P ≤ .001) and surfactant use (40 [43%] compared with 149 [57%]; P = .02). Adjusting for confounding variables, multiple courses of steroids were significantly associated with a 65% reduction in the incidence of RDS (odds ratio 0.35; 95% confidence interval = 0.18, 0.70; P = .003). Conclusion: Compared with single courses, multiple courses of antenatal steroids reduced significantly the incidence of RDS with no apparent increase in neonatal sepsis or disturbances in fetal growth.

Effect of Single Versus Multiple Courses of Antenatal Steroids on Neonatal Outcome of Very Low Birthweight Infants

Effect of Single Versus Multiple Courses of Antenatal Steroids on Neonatal Outcome of Very Low Birthweight Infants

Effect of Multiple Courses of Antenatal Steroids as Compared to Single Course on Neonatal Lung Mechanics

Effect of Multiple Courses of Antenatal Steroids as Compared to Single Course on Neonatal Lung Mechanics

Effect of Single Versus Multiple Courses of Antenatal Steroids on Neonatal Outcome • 938

Effect of Single Versus Multiple Courses of Antenatal Steroids on Neonatal Outcome • 938

Repeated Antenatal Corticosteroids: Growth and Early Childhood Outcome

Aim: To determine the effects of repeated antenatal corticosteroids on size at birth and later growth and development in Very Preterm (<33 weeks) singleton infants. Design: Prospective regional cohort study (n=664). Exclusions: maternal preeclampsia(n=215), no information on steroid use (n=23). Factors Examined: demographic/obstetric history, size at birth, a/n steroids grouped as none(G0, n=233), one (G1, n=93), two (G2, n=76) or three plus courses (G3, n=24), size at 3 years, Stanford Binet IQ test results at 3 yrs. Results: Significantly more infants had birthweight <10% in G2 and G3 (G0=14.6%, G1=10.8%, G2=19.7%, G3=33.3%). Multivariate analysis showed a progressive reduction in birthweight and head circumference with increasing steroid courses. Infants in G3 had a reduction of 122g and 0.87 cm compared to G0. Steroid use did not affect birth length, growth parameters at three years, disability or IQ outcomes. Conclusions: Multiple courses of antenatal steroids are associated with significant reductions in birthweight and head circumference. These factors have the potential to affect long term outcomes though an independent long term effect was not evident in this cohort.