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[Antepartum prevention and postnatal therapy of respiratory distress syndrome]
L Schrod1, P Albert, G Frauendienst-Egger
1Kinderklinik und Poliklinik, Universität Würzburg.
Insights
Surfactant therapy improves outcomes for premature infants with respiratory distress syndrome (RDS). Antepartum corticosteroids enhance surfactant's effect, reducing mortality in high-risk neonates.
Area of Science:
- Neonatology
- Pulmonology
- Obstetrics
Background:
- Respiratory distress syndrome (RDS) is a significant cause of mortality in premature infants.
- Surfactant therapy has reduced mortality and complications in very premature infants.
- Obstetric management critically influences neonatal outcomes.
Purpose of the Study:
- To evaluate the impact of antepartum corticosteroid therapy on mortality in premature infants with RDS treated with surfactant.
- To explore the synergistic effects of corticosteroids and surfactant on the immature lung.
- To emphasize the importance of fetal lung maturity assessment for optimal surfactant administration.
Main Methods:
- Prospective study of 116 premature infants with RDS treated with natural surfactant preparations.
- Analysis of mortality rates in infants receiving antepartum corticosteroid therapy versus those who did not.
- Consideration of factors like fetal asphyxia, meconium aspiration, lung hypoplasia, and perinatal infection.
Main Results:
- Antepartum corticosteroid therapy significantly reduced mortality in premature infants with RDS treated with surfactant.
- A synergistic effect between corticosteroids and surfactant on the immature lung is suggested.
- Delayed surfactant replacement may be less beneficial than early administration, but reliable fetal lung maturity assessment is crucial to avoid unnecessary treatment.
Conclusions:
- Antepartum corticosteroids enhance the benefits of surfactant therapy in premature infants with RDS.
- Optimizing obstetric management and timing of surfactant administration are key to improving outcomes.
- Multidisciplinary collaboration between obstetricians and neonatologists is essential for managing complex cases of neonatal respiratory distress.
Abstract:
The introduction of surfactant in the therapy of respiratory distress syndrome (RDS) reduced mortality and long term complications in very premature infants. Nevertheless, the obstetric management influences critically the outcome. In a prospective study of 116 premature infants with RDS treated with natural surfactant preparations after birth, mortality was significantly reduced by antepartum corticosteroid therapy suggesting a synergistic effect of corticosteroids and surfactant on the immature lung. It is assumed that a preventive administration of surfactant immediately after birth would benefit neonates at risk for RDS more than a delayed surfactant replacement after the development of RDS. But without a reliable assessment of fetal lung maturity before birth more than 50% of our premature infants with birth weights less than 1500 g would be exposed to surfactant unnecessarily. It is important that fetal asphyxia is avoided. Acquired respiratory distress syndrome occur even in premature infants after shock or meconium aspiration and may respond poorly to surfactant replacement. This is also the case in lung hypoplasia or perinatal infection, where the combined efforts of obstetricians and neonatologists are needed to attain better results.