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Antenatal corticosteroids for periviable birth.

Ronald J Wapner1

  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 W. 168th St, New York, NY 10032.

Seminars in Perinatology
|December 3, 2013
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Antenatal corticosteroids accelerate fetal lung development, reducing complications for preterm infants. Their use between 23-26 weeks gestation is recommended, though benefits at 22 weeks are less clear.

Keywords:
Antenatal corticosteroidsBetamethasonePeriviable birth

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Area of Science:

  • Perinatology
  • Neonatology
  • Developmental Biology

Background:

  • Antenatal corticosteroids (ACS) are established to improve outcomes for preterm neonates between 28-34 weeks gestation.
  • Limited evidence exists for ACS use in the periviable period (22-26 weeks).

Purpose of the Study:

  • To evaluate the efficacy and safety of antenatal corticosteroids in the periviable period (22-26 weeks gestation).
  • To provide guidance on ACS use for high-risk preterm births in this critical gestational window.

Main Methods:

  • Review of laboratory studies on the biological plausibility of ACS in early gestation.
  • Analysis of cohort studies examining neonatal mortality and intraventricular hemorrhage (IVH) rates.
  • Assessment of follow-up data at 18-22 months for long-term developmental outcomes.

Main Results:

  • Laboratory data support the biological rationale for ACS effectiveness in the periviable period.
  • Cohort studies indicate ACS reduce neonatal mortality and IVH in this gestational range.
  • Long-term follow-up suggests sustained benefits of ACS initiated between 23-26 weeks.

Conclusions:

  • Antenatal corticosteroids are recommended for patients at high risk of preterm birth between 23-26 weeks gestation.
  • The benefit of ACS at 22 weeks gestation remains uncertain and requires further investigation.