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[Perinatal corticotherapy: updates]
1Soins Intensifs et Réanimation Néonatals, Maternité Régionale Universitaire de Nancy, 10, rue du Dr Heydenreich, 54042 Nancy.
Summary
Antenatal corticosteroid treatment improves lung function in premature infants, reducing respiratory distress. Careful evaluation of treatment courses and steroid type (betamethasone preferred) is crucial to maximize benefits and minimize side effects.
Area of Science:
- Neonatal Medicine
- Pulmonology
- Pharmacology
Context:
- Antenatal corticosteroid therapy is established for fetal lung maturation.
- Postnatal corticosteroid use benefits neonates with chronic lung disease.
- Optimal treatment protocols require further refinement.
Purpose:
- To review recent data on antenatal and postnatal corticosteroid use.
- To suggest an updated treatment policy for improved neonatal outcomes.
- To address remaining questions regarding efficacy and safety.
Summary:
- Antenatal corticosteroids significantly reduce severe respiratory distress syndrome (RDS) risk, with benefits observed as early as 23 weeks gestation.
- Treatment efficacy is linked to gestational age and number of courses; benefits may be outweighed by side effects after 3 courses.
- Betamethasone is favored over dexamethasone due to a lower risk of neurological complications. Postnatal use is reserved for severe chronic lung disease, with pulse therapy as the preferred method.
Impact:
- Updated treatment policies can improve the prognosis for premature infants.
- Evidence supports the preferential use of betamethasone for antenatal and postnatal corticosteroid therapy.
- Optimizing treatment intervals and administration methods (pulse therapy) can enhance safety and efficacy.