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[Analysis of selected methods for intrauterine stimulation of fetal pulmonary maturation]
A Sledziewski1, M Kinalski, A Kretowski
1Zakład Rozwoju Płodu i Noworodka, Instytut Matki i Dziecka w Białymstoku.
Insights
Antenatal corticosteroids significantly reduce complications in premature infants. This treatment enhances fetal lung maturity, improving neonatal outcomes and potentially lowering healthcare costs.
Area of Science:
- Perinatology and Neonatology
- Fetal Development and Pulmonary Medicine
Context:
- Preterm delivery is a leading cause of infant morbidity and mortality.
- Respiratory Distress Syndrome (RDS) is a primary complication, affecting a high percentage of premature infants.
Purpose:
- To critically review current literature on antenatal treatments for anticipated preterm deliveries.
- To evaluate the efficacy and mechanisms of antenatal corticosteroids in promoting fetal pulmonary maturity.
Summary:
- Meta-analyses confirm glucocorticoid therapy effectively reduces prematurity-related pathologies.
- The review details hormonal effects on fetal lung development, glucocorticoid mechanisms, and potential maternal effects.
- Antenatal corticosteroids enhance surfactant system components and antioxidant enzymes, improving respiratory outcomes.
Impact:
- Provides strong evidence supporting the use of antenatal corticosteroids for fetal lung maturation.
- Demonstrates improved neonatal outcomes and potential for significant healthcare cost savings.
Abstract:
Preterm delivery is still a major cause of infant morbidity and mortality. Premature infants develop numerous complications including respiratory distress syndrome, intraventricular hemorrhage, patent ductus arteriosus, necrotising enterocolitis, etc. Respiratory distress syndrome is the leading problem in perinatology. The incidence of RDS accounts for 70% of all infants delivered before 30 week's gestation and about 20% neonates born between 32-37 week of pregnancy. Our paper presents current opinions and is a critical review of relevant literature on antenatal treatment before anticipated preterm deliveries. Recently performed meta-analysis prove that glucocorticoid therapy is effective in reducing aforementioned pathologies of prematurity. After brief account on effects of several hormones on fetal pulmonary maturity some beneficial interactions for enhanced fetal maturity are pointed out. Glucocorticoid mechanism of action in target cells and its biochemical implications are reviewed. The use of antenatal corticoids for fetal maturation and possible adverse maternal effects follow. Finally both short-term and long-term benefits of ANS are discussed. Thus there are convincing data to support the use of ANS in fetal pulmonary maturation. The current findings suggest that the improvement of respiratory outcome may depend on enhanced expression of phospholipids and proteins of the surfactant system and enzymes of antioxidant systems. We believe that use of antenatal corticosteroids for fetal maturation results in improvement of neonatal outcome and yields substantial savings in health care costs.