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[Prenatal steroid treatment--a 4-year material]
S H Anderssen1, I E Silberg, B Oglaend
1Barneavdelingen, Ostfold sentralsykehus, Fredrikstad.
Insights
Prenatal steroid treatment for preterm infants significantly reduces respiratory distress syndrome and mortality. Expanded gestational age recommendations (24-33 weeks) align with improved infant outcomes and increased surfactant use.
Area of Science:
- Neonatal Medicine
- Obstetrics
- Pharmacology
Background:
- Prenatal steroids are established treatments to prevent respiratory distress syndrome (RDS) and mortality in preterm infants.
- Historically, treatment was recommended between 28 and 32 weeks of gestation.
- Current recommendations have expanded to cover 24 to 33 weeks of gestation, with few contraindications.
Purpose of the Study:
- To evaluate the impact of prenatal steroid administration on outcomes in preterm infants under 33 weeks gestational age.
- To assess changes in mortality and RDS rates coinciding with updated treatment guidelines and increased surfactant use.
Main Methods:
- Retrospective analysis of infants born before 33 weeks gestational age between 1990-1993.
- Comparison of outcomes (mortality, RDS) between infants who received prenatal steroids and those who did not.
- Correlation of treatment trends with surfactant administration and infant mortality rates.
Main Results:
- Prenatal steroid administration in infants under 33 weeks significantly reduced RDS (61% vs 82%) and mortality (3.6% vs 18%).
- Infant mortality rates decreased from 18% (1990-1991) to 6% (1992-1993), coinciding with increased use of surfactant and prenatal steroids.
- No adverse maternal or infant complications were attributed to prenatal steroid use.
Conclusions:
- Expanded use of prenatal steroids (24-33 weeks) is associated with significant reductions in mortality and RDS in preterm infants.
- The findings support adherence to current guidelines for prenatal steroid administration.
- Increased surfactant use alongside prenatal steroids may contribute synergistically to improved neonatal outcomes.
Abstract:
Prenatal steroids have been used for more than 20 years to prevent respiratory distress syndrome and death in preterm infants. Previously the treatment was recommended from the 28th to the 32nd gestational week. It is now recommended, with very few contradictions, from the 24th to the 33rd gestational week. From 1990 to 93, 56 (39%) of 145 infants under 33 weeks were given prenatal steroids. Amongst the steroid-treated infants there were significantly fewer deaths and fewer respiratory distress syndromes (3.6% vs 18%, p < 0.02 and 61% vs 82%, p < 0.01). Mortality at this age fell from 18% in 1990/1991 to 6% in 1992/1993 (p = 0.019), coinciding with an increase in the use of surfactant from 5% to 30% (p < 0.01) and prenatal steroids from 31% to 46% (p = 0.028). No specific complications that could be attributed to steroids were recorded in either mother or infant. Had the new recommendations applied, a further 28 infants under 33 gestational weeks (58% of all) would have been treated with prenatal steroids.