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Prenatal corticosteroid therapy for elevated liver enzyme/low platelet count syndrome: a case report
Najm S Qureshi1, Anthony J Tomlinson
1Women's Health Directorate, Royal Bolton Hospital, Minerva Road, Bolton BL4 OJR, UK. nsq@doctors.org.uk
Insights
Elevated liver enzymes/low platelet count (ELLP) syndrome in early preterm infants can be stabilized with prenatal corticosteroids. However, this treatment may increase the risk of intrauterine fetal death.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Neonatology
Background:
- Early preterm onset of elevated liver enzymes/low platelet count (ELLP) syndrome presents significant clinical management challenges.
- ELLP syndrome requires effective interventions to improve maternal and fetal outcomes.
Observation:
- Antepartum methylprednisolone (40 mg/d IV) was administered at 25 weeks and 5 days gestation to stabilize ELLP syndrome and promote fetal lung maturity.
- Corticosteroid treatment led to normalization of liver transaminases and platelet counts.
Findings:
- While methylprednisolone stabilized biochemical and hematologic parameters of ELLP syndrome, it was associated with sudden fetal death at 28 weeks and 2 days gestation.
- The study highlights a potential trade-off between maternal treatment benefits and fetal risks.
Implications:
- Prenatal corticosteroid use for ELLP syndrome may offer biochemical and hematologic improvements.
- Clinicians must carefully weigh the potential benefits against the risk of intrauterine fetal demise when considering corticosteroid therapy for ELLP syndrome.
Background:
Early preterm onset of elevated liver enzymes/low platelet count (ELLP) syndrome poses a significant management problem.
Case:
Antepartum methylprednisolone, 40 mg/d intravenously was employed to stabilize ELLP syndrome, to achieve fetal lung maturity and to postpone delivery at 25 weeks and 5 days' gestation. Normalization of the liver transaminases and platelet count occurred with the use of corticosteroids, but sudden fetal death occurred at 28 weeks and 2 days' gestation.
Conclusion:
Prenatal corticosteroids may improve the biochemical and hematologic parameters of ELLP syndrome but may result in intrauterine death.
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