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Antenatal steroids

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https://www.readbyqxmd.com/read/28538237/update-on-postnatal-steroids
#1
Henry L Halliday
Antenatal steroid treatment to enhance fetal lung maturity and surfactant treatment to prevent or treat respiratory distress syndrome have been major advances in perinatal medicine in the past 40 years contributing to improved outcomes for preterm infants. Use of postnatal steroids to prevent or treat chronic lung disease in preterm infants has been less successful and associated with adverse neurodevelopmental outcomes. Although early (in the first week of life) postnatal steroid treatment facilitates earlier extubation and reduces the risk of chronic lung disease, it is associated with adverse effects, such as hyperglycemia, hypertension, gastrointestinal bleeding and perforation, hypertrophic cardiomyopathy, growth failure, and cerebral palsy, and cannot be recommended...
2017: Neonatology
https://www.readbyqxmd.com/read/28538235/what-should-we-do-about-low-blood-pressure-in-preterm-infants
#2
Eugene M Dempsey
The management of preterm infants with low blood pressure soon after birth remains unresolved. The definition of what constitutes low blood pressure is uncertain. At birth, mean blood pressure appears to be gestation specific and increases in the first few days of life. Antenatal steroids, delayed cord clamping, and the avoidance of mechanical ventilation are all associated with higher mean blood pressure and less hypotension after birth. Rates of hypotension of 15-50% have been reported in various studies of extremely preterm infants...
2017: Neonatology
https://www.readbyqxmd.com/read/28528221/bronchopulmonary-dysplasia-and-perinatal-characteristics-predict-1-year-respiratory-outcomes-in-newborns-born-at-extremely-low-gestational-age-a-prospective-cohort-study
#3
Roberta L Keller, Rui Feng, Sara B DeMauro, Thomas Ferkol, William Hardie, Elizabeth E Rogers, Timothy P Stevens, Judith A Voynow, Scarlett L Bellamy, Pamela A Shaw, Paul E Moore
OBJECTIVE: To assess the utility of clinical predictors of persistent respiratory morbidity in extremely low gestational age newborns (ELGANs). STUDY DESIGN: We enrolled ELGANs (<29 weeks' gestation) at ≤7 postnatal days and collected antenatal and neonatal clinical data through 36 weeks' postmenstrual age. We surveyed caregivers at 3, 6, 9, and 12 months' corrected age to identify postdischarge respiratory morbidity, defined as hospitalization, home support (oxygen, tracheostomy, ventilation), medications, or symptoms (cough/wheeze)...
May 17, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28514779/low-back-pain-in-pregnancy-investigations-management-and-role-of-neuraxial-analgesia-and-anaesthesia-a-systematic-review
#4
Herman Sehmbi, Rohan D'Souza, Anuj Bhatia
BACKGROUND: Low back pain (LBP) is commonly experienced during pregnancy and is often poorly managed. There is much ambiguity in diagnostic work-up, appropriate management and decision-making regarding the use of neuraxial analgesia and anaesthesia during labour and delivery in these patients. This systematic review summarises the evidence regarding investigations, management strategies and considerations around performing neuraxial blocks for pregnant women with LBP. METHODS: We searched 3 databases and reviewed literature concerning LBP in pregnancy with regards to diagnostic modalities, management strategies and use of neuraxial techniques for facilitating labour and delivery...
May 18, 2017: Gynecologic and Obstetric Investigation
https://www.readbyqxmd.com/read/28486361/universal-cervical-length-screening-and-antenatal-corticosteroid-timing
#5
Nicole Sahasrabudhe, Catherine Igel, Ghislaine C Echevarria, Peʼer Dar, Diana Wolfe, Peter S Bernstein, Robert Angert, Ashlesha Dayal, Patience Gallagher, Mara Rosner
OBJECTIVE: To evaluate the relationship between universal transvaginal screening for short cervical length in the second trimester and the timing of antenatal corticosteroids. METHODS: We performed a retrospective cohort study of patients with nonanomalous singleton gestations and spontaneous preterm birth between 24 and 34 weeks of gestation after the initiation of a universal transvaginal cervical length screening program between October 2012 and August 2015. Our primary outcome was antenatal corticosteroid administration to a delivery interval of fewer than 7 days...
June 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28455087/assessing-the-potential-impact-of-extending-antenatal-steroids-to-the-late-preterm-period
#6
Vivienne Souter, Ellen Kauffman, Ms Alice J Marshall, Jodie G Katon
BACKGROUND: In 2016 guidance statements were issued by the Society for Maternal Fetal Medicine and by the American College of Obstetricians and Gynecologists about extending antenatal steroid use to selected late preterm singleton pregnancies. OBJECTIVE: To review antenatal steroid use prior to the 2016 guidance statements and assess the potential impact of these. STUDY DESIGN: This cohort study used chart-abstracted data from singleton deliveries from January 1, 2012 to March 31, 2016 at 12 centers participating in the Obstetrics Clinical Outcomes Assessment Program, a quality initiative in Washington State...
April 25, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28454696/effect-of-glucocorticoids-on-mechanisms-of-placental-angiogenesis
#7
Aslı Ozmen, Gozde Unek, Emin Turkay Korgun
The benefits of antenatal glucocorticoid (GC) treatment to promote human fetal lung maturation are well established. However, reports have emerged indicating that maternal exposure to high concentrations of circulating GCs alters placental and fetal development. Because many adult-onset metabolic and cardiovascular disorders have their origins in utero, the importance of prenatal conditions should be considered in detail. Therefore, this review aims to present an overview of the GC effect on placental and fetal development, specifically with regard to mechanisms of placental angiogenesis...
April 2017: Placenta
https://www.readbyqxmd.com/read/28436580/pulmonary-function-and-outcomes-in-infants-randomized-to-a-rescue-course-of-antenatal-steroids
#8
Cindy McEvoy, Diane Schilling, Patricia Spitale, Jean O'Malley, Susan Bowling, Manuel Durand
BACKGROUND/OBJECTIVE: Our objective was to obtain follow-up pulmonary function testing and assessment of clinical respiratory outcomes, at 1-2 years, in preterm infants whose mothers were randomized to a single rescue course of antenatal steroids (AS) versus placebo. METHODS: Follow-up of a randomized, double-blinded trial. In the original trial pregnant women ≥14 days after initial course of AS were randomized to rescue AS or placebo. Pulmonary function testing and a standardized respiratory questionnaire were obtained at 1-2 years of corrected age...
April 24, 2017: Pediatric Pulmonology
https://www.readbyqxmd.com/read/28425254/wheezing-asthma-and-atopy-in-premature-infants-at-2-years-of-age
#9
Sevim Ünal, Ayşenur Kaya, Leyla Bilgin, Emine Misirlioğlu, Can Naci Kocabaş
BACKGROUND/AIM: We aimed to evaluate wheezing, bronchial asthma (BA), and atopy in premature infants at 2 years of age via a cross-sectional study. MATERIALS AND METHODS: Premature infants at <37 weeks of gestational age (GA) were assessed for atopy by skin-prick test and serum immunoglobulin E level at 2 years of age. The family's and infant's histories of allergy, BA, atopy, and wheezing were obtained by questionnaire and from hospital records. RESULTS: There were 98 infants, with mean birth weight (BW) 1517...
April 18, 2017: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/28419552/feasibility-and-utility-of-portable-ultrasound-during-retrieval-of-sick-preterm-infants
#10
Kathryn Browning Carmo, Tracey Lutz, Mark Greenhalgh, Andrew Berry, Martin Kluckow, Nick Evans
AIM: Document the incidence of haemodynamic pathology in critically ill preterm newborns requiring transport. METHOD: A transport neonatologist performed cardiac and cerebral ultrasound before and after transportation of infants born ≤ 30 weeks gestation. RESULTS: 44 newborns were studied 2008 - 2015, 21 transported by road, 19 by helicopter and 4 by fixed wing. Median birth weight 1130g (680-1960g), median gestation 27 weeks (23-30) and 30/44 were male...
April 17, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28388600/influence-of-antenatal-glucocorticoid-on-preterm-lamb-diaphragm
#11
Tanzila Mahzabin, J Jane Pillow, Gavin J Pinniger, Anthony J Bakker, Peter B Noble, Robert B White, Kanakeswary Karisnan, Yong Song
BACKGROUND: Pregnant women at high risk of preterm delivery receive glucocorticoids to accelerate fetal lung maturation and surfactant synthesis. However, the effect of antenatal steroids on the developing diaphragm remains unclear. We hypothesized that maternal betamethasone impairs the fetal diaphragm, and the magnitude of the detrimental effect increases with longer duration of exposure. We aimed to determine how different durations of fetal exposure to maternal betamethasone treatment influence the fetal diaphragm at the functional and molecular levels...
April 7, 2017: Pediatric Research
https://www.readbyqxmd.com/read/28384953/neonatal-airway-compromise-by-a-giant-cervicothoracic-venous-haemangioma
#12
Janardhan Shenoy, Anita Coutinho, Sowmini P Kamath, Suresh Pai, Santosh Pv Rai
Haemangiomas are most common non-malignant vascular tumours of infancy. Here, we describe an antenatally detected mass over the neck causing compressive respiratory compromise at birth requiring resuscitative measures at birth. The mass showed increased vascularity on Contrast Enhanced Computed Tomography (CECT) with extension upto superior mediastinum. Surgical excision was required following failure to medical measures with steroids and propranolol. Histopathology confirmed it to be a venous haemangioma. This case highlights that these benign lesions may reach large sizes and antenatal detection may help in planning effective delivery and resuscitative measures...
February 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28383536/variation-in-quality-report-viewing-by-providers-and-correlation-with-nicu-quality-metrics
#13
N Wahid, M V Bennett, J B Gould, J Profit, B Danielsen, H C Lee
BACKGROUND: To examine variation in quality report viewing and assess correlation between provider report viewing and neonatal intensive care unit (NICU) quality. METHODS: Variation in report viewing sessions for 129 California Perinatal Quality Care Collaborative NICUs was examined. NICUs were stratified into tertiles based on their antenatal steroid (ANS) use and hospital-acquired infection (HAI) rates to compare report viewing session counts. RESULTS: The number of report viewing sessions initiated by providers varied widely over a 2-year period (median=11; mean=25...
April 6, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28338487/the-evolution-of-disease-chronic-lung-disease-of-infancy-and-pulmonary-hypertension
#14
Michael C Tracy, David N Cornfield
PURPOSE OF REVIEW: Bronchopulmonary dysplasia (BPD) or chronic lung disease of infancy BPD was originally described 50 years ago, in 1967 by Northway et al. This article possesses two fundamental objectives to provide: a brief historical perspective on BPD; and an update relative to current notions of epidemiology, pathophysiology, evaluation, and clinical management of BPD complicated by vascular disease. The review highlights areas of consensus and ongoing uncertainty. RECENT FINDINGS: The clinical cause and presentation of infants with BPD has evolved over the past several decades...
June 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28337030/prenatal-steroid-administration-leads-to-adult-pericardial-and-hepatic-steatosis-in-male-baboons
#15
A H Kuo, J Li, C Li, H F Huber, M Schwab, P W Nathanielsz, G D Clarke
Developmental programming studies indicate that glucocorticoids modify fetal development. We hypothesized that administration of the synthetic glucocorticoid (sGC) betamethasone to pregnant baboons at doses and stages of fetal life equivalent to human obstetric practice to decrease premature offspring morbidity and mortality, programs lipid metabolism. In 10-year-old male baboons (human equivalent 40) exposed in fetal life to betamethasone or saline, we quantified pericardial fat and hepatic lipid content with magnetic resonance imaging and spectroscopy...
April 18, 2017: International Journal of Obesity: Journal of the International Association for the Study of Obesity
https://www.readbyqxmd.com/read/28333158/antenatal-late-preterm-steroids-alps-are-we-ready-to-accept-it
#16
S Kamatkar, A Jobe
No abstract text is available yet for this article.
June 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28321847/antenatal-corticosteroids-for-accelerating-fetal-lung-maturation-for-women-at-risk-of-preterm-birth
#17
REVIEW
Devender Roberts, Julie Brown, Nancy Medley, Stuart R Dalziel
BACKGROUND: Respiratory morbidity including respiratory distress syndrome (RDS) is a serious complication of preterm birth and the primary cause of early neonatal mortality and disability. While researching the effects of the steroid dexamethasone on premature parturition in fetal sheep in 1969, Liggins found that there was some inflation of the lungs of lambs born at gestations at which the lungs would be expected to be airless. Liggins and Howie published the first randomised controlled trial in humans in 1972 and many others followed...
March 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28295991/antenatal-corticosteroids-it-s-all-about-timing
#18
Cynthia Gyamfi-Bannerman
Antenatal corticosteroids have been shown consistently to improve respiratory and other outcomes for infants born preterm (Roberts D et al. Cochrane database of systematic reviews. 2006(3):CD004454). Since Liggins and Howie we know that timing of corticosteroid administration influences the likelihood of benefit (Liggins GC et al. Pediatrics. 1972;50(4):515-525; Ring AM et al. Am J Obstet Gynecol. 2007;196(5):457 e451-456). In fact, the lack of benefit after seven days in their trial led to numerous studies evaluating serial administration of steroids...
March 11, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28294496/timing-of-antenatal-corticosteroid-administration-and-survival-in-extremely-preterm-infants-a-national-population-based-cohort-study
#19
H Norberg, J Kowalski, K Maršál, M Norman
OBJECTIVE: To explore the association between administration-to-birth interval of antenatal corticosteroids (ACS) and survival in extremely preterm infants. DESIGN: Population-based prospective cohort study. SETTING: All obstetric and neonatal units in Sweden from 1 April 2004 to 31 March 2007. POPULATION: All live-born infants (n = 707) born at 22-26 completed weeks of gestation. METHODS: The relationship between time from first administration of ACS to delivery and survival was investigated using Cox proportional hazards regression analysis...
March 15, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28277921/does-implementing-a-regime-of-dexamethasone-before-planned-cesarean-section-at-term-reduce-admission-with-respiratory-morbidity-to-neonatal-intensive-care-unit-a-randomized-controlled-trial
#20
Ahmed Mohamed Nooh, Hussein Mohammed Abdeldayem, Eisa Arafa, Sherin Attia Shazly, Hany Elsayed, Wesam A Mokhtar
OBJECTIVE: To assess effectiveness of Dexamethasone before plannedcesarean section at term in reducing admission with respiratory morbidity to neonatal intensive care units. METHODS: A prospective randomized controlled trial which was conducted at an Egyptian teaching hospital. Participants at ≥ 38 weeks gestation who were planned to have planned CS were recruited. They were randomized into a treatment group (636 women) who received three IM doses of Dexamethasone 8 mg, 8 hours apart, and control group (636 women) who have not received Dexamethasone, before having planned CS...
February 9, 2017: Journal of Maternal-fetal & Neonatal Medicine
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