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[Prenatal corticosteroid and early surfactant therapy in infants born at < or = 30 weeks gestation]
A Valls i Soler1, S Páramo Andrés, B Fernández-Ruanova
1Unidad Neonatal, Departamento de Pediatría, Hospital de Cruces, Universidad del País Vasco/EHU, Baracaldo, Bilbao, Spain. enadolf@eresmas.net
Insights
Prenatal corticosteroids (PNC) in very low birth weight infants (VLBWI) reduced mortality and complications when given with early surfactant therapy. However, PNC did not decrease the incidence of chronic lung disease in these infants.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Perinatal Medicine
Context:
- Very low birth weight infants (VLBWI) often require respiratory support.
- Prenatal corticosteroid (PNC) exposure and postnatal surfactant therapy are standard treatments.
- The role of PNC in preventing chronic lung disease in VLBWI is debated.
Purpose:
- To evaluate the impact of prenatal corticosteroid (PNC) exposure on outcomes in VLBWI born at or before 30 weeks' gestation.
- To compare outcomes between VLBWI exposed to PNC and those not exposed, who received early surfactant therapy.
Summary:
- A multicenter study analyzed 211 VLBWI born at <= 30 weeks' gestation who received early surfactant therapy.
- PNC-exposed infants (n=157) showed reduced neonatal mortality, intraventricular hemorrhage, patent ductus arteriosus, and necrotizing enterocolitis compared to non-exposed infants (n=54).
- PNC exposure was associated with earlier surfactant administration, fewer doses, earlier extubation, and lower FiO2 requirements, but did not reduce chronic lung disease incidence.
Impact:
- Prenatal corticosteroids may improve survival and reduce major morbidities in preterm infants receiving surfactant.
- The findings suggest PNC is beneficial for VLBWI but does not prevent chronic lung disease.
- This research contributes to optimizing respiratory management strategies for extremely preterm infants.
Background:
Prenatal corticosteroid (PNC) exposure and postnatal surfactant therapy improve outcome in very low birth weight infants (VLBWI). However, the efficacy of PNC in the prevention of chronic lung disease is debated.
Objective:
To study the effects of PNC exposure on outcome in VLBWI born at < or = 30 weeks' gestation.
Patients And Methods:
We performed a multicenter, longitudinal study. The Spanish Surfactant Group database (n 5 1,275) was searched and 211 VLBWI born at < or = 30 weeks who received early surfactant therapy (< or = 30 min) were identified. Perinatal events, neonatal management and rates of mortality and complications were evaluated. Data on the subgroup of infants who received PNC (157, 74.4 %) were compared with data on 54 infants who did not receive this therapy.
Results:
Mean (+/- SD) birth weight and gestational age were 944 (226) g and 27 (1.8) weeks. Surfactant was given at 16 +/- 13 min (61 % < or = 15 min). A total of 124 infants (58.8 %) developed respiratory distress syndrome. No differences were found in birth weight, gestational age, or Apgar score at 1 and 5 min. However the age at first surfactant dose was lower in infants exposed to PNC. PNC-exposed infants required fewer doses of surfactant, were extubated earlier (58.9 vs. 161 h) and needed a lower FiO2 at 48 h (0.28 vs. 0.35). Moreover, neonatal mortality (15.9 vs. 27.8 %), the incidence of intraventricular hemorrhage (25.2 vs. 50 %), ductus arteriosus (40.3 vs. 63.5 %) and necrotizing enterocolitis (9 vs. 19.2 %) were lower in infants receiving PNC. However, the incidence of chronic lung disease was similar in both groups.
Conclusions:
PNC exposure of VLBWI born at < or = 30 weeks receiving early surfactant therapy reduced mortality and the incidence of certain complications but did not decrease the incidence of chronic lung disease.
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