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Pulmonary Function at Hospital Discharge in Preterm Infants Randomized to a Single Rescue Course of Antenatal
Brian K Jordan1, Diane Schilling1, Cindy T McEvoy1
1Department of Pediatrics, Division of Neonatology, Oregon Health & Science University, Portland, OR.
Insights
A single rescue course of antenatal steroids improved infant pulmonary function at birth. While the benefit persisted until hospital discharge, placebo infants showed improved pulmonary compliance over time.
Area of Science:
- Neonatal Medicine
- Pulmonary Medicine
- Pharmacology
Background:
- Antenatal steroid administration is crucial for fetal lung maturation.
- The optimal timing and dosage for rescue courses remain areas of investigation.
- Previous studies indicated potential benefits of rescue antenatal steroids for neonatal respiratory outcomes.
Purpose of the Study:
- To compare pulmonary function in infants whose mothers received a single rescue course of antenatal steroids versus placebo.
- To evaluate changes in pulmonary mechanics from birth to hospital discharge.
Main Methods:
- A randomized, double-blinded trial involving pregnant women at <34 weeks' gestation, at least 14 days after an initial antenatal steroid course.
- Infants were randomized to receive either rescue antenatal steroids or placebo.
- Passive respiratory compliance (Crs), resistance, and functional residual capacity were measured at birth and hospital discharge.
Main Results:
- Infants in the rescue antenatal steroid group had higher Crs within 72 hours of birth compared to placebo (1.21 vs 1.01 mL/cm H2O/kg).
- This enhanced Crs in the antenatal steroid group was sustained until hospital discharge.
- Infants in the placebo group showed significant improvement in Crs by discharge, reaching levels comparable to the antenatal steroid group (1.18 vs 1.22 mL/cm H2O/kg).
Conclusions:
- A single rescue course of antenatal steroids significantly improved infant respiratory compliance shortly after birth.
- The observed improvement in respiratory compliance was sustained until hospital discharge.
- While initially lower, preterm infants in the placebo group demonstrated catch-up improvement in respiratory compliance by discharge.
Objective:
To compare the pulmonary function, measured at birth and at hospital discharge, of infants whose mothers had been randomized to a single rescue course of antenatal steroids versus those whose mothers had been randomized to placebo.
Study Design:
This study involved follow-up at hospital discharge of subjects of a randomized, double-blinded trial. In the original trial, pregnant women at ≥14 days after their initial course of antenatal steroids and <34 weeks' gestation were randomized to rescue antenatal steroids (44 mothers, 56 infants) or placebo (41 mothers, 57 infants). Passive respiratory compliance (Crs), passive respiratory resistance, and functional residual capacity were measured in all infants at birth and again at discharge to evaluate changes in pulmonary mechanics over time. Statistical analyses were based on intention to treat.
Results:
We previously reported that compared with infants in the placebo group, infants in the rescue antenatal steroids group had a higher mean Crs value measured within 72 hours of birth (1.21 vs 1.01 mL/cm H2O/kg; P < .05). Here we show that the Crs benefit in the antenatal steroids group was sustained until discharge. Infants in the placebo group demonstrated improvement in Crs such that by discharge, there was no difference in mean Crs between the rescue antenatal steroids and placebo groups (1.18 vs 1.22 mL/cm H2O/kg).
Conclusions:
Rescue antenatal steroids significantly increased Crs measured within 72 hours of birth, and this increase was sustained until hospital discharge. Preterm infants in the placebo group demonstrated a decreased initial Crs compared with the rescue antenatal steroids group, but achieved a comparable Crs by the time of discharge.
Trial Registration:
ClinicalTrials.gov: NCT00669383.
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