Abstract
Antenatal corticosteroid administration has been unequivocally demonstrated to reduce neonatal morbidity and mortality. In addition to its well-documented role in reducing respiratory distress syndrome, evidence is accumulating indicating the global maturational effect of this therapy in the growing fetus. New data demonstrates, the hitherto relatively not well known, beneficial effects of this mode of therapy on renal, cardiovascular, gastrointestinal, endocrinal and cerebral maturation. Despite its well proven efficacy and safety, this therapy is used only in a small fraction of eligible mothers. In this article, biological basis of antenatal steroids use, clinical benefits including those to extremely premature infants, indications for their administration, treatment regimens, practice variations in their administration, cost analysis, and some directions for future research are reviewed. It is hoped that given the evidence reviewed in this article, the use of antenatal steroids administration in proper clinical settings will increase with a significant impact in reducing the neonatal morbidity and mortality.
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References
Effect of Corticosteroids for Fetal lung maturation on Perinatal Outcomes.NIH Consensus Statement 1994 Feb 28-Mar 2; 12(2): 11–25.
Crowley P. Antenatal corticosteroid therapy: A meta-analysis of the randomized trials: 1972–1994.Am J Obstet Cynecol 1995; 173: 322–335.
Padbury JF, Ervin MG, Polk DH. Extrapulmonary effects of antenatally administered steroids.J Ped 1996; 128: 167–172.
Ballard PL, Granberg P, Ballard RA. Glucocorticoid levels in maternal and cord serum after prenatal betamethasone therapy to prevent respiratory distress syndrome.J Clin Invest 1975; 56: 1548–1554.
Ballard PL. Antenatal glucocorticoid therapy: hormone concentrations. In: Ballrd PL, (Ed.),Hormones and Lung Maturation, New York: Springer-Verlag, 1986; 173–196.
Ballard PL, Ballard RA. Scientific basis and therapeutic regimens for use of antenatal glucocorticoids.Am J Obstet Gynecol 1995; 173: 252–262.
Frank L, Lewis PL, Sosenko IRS. Dexamethasone stimulation of fetal rat lung antioxidant enzyme activity in parallel with surfactant stimulation.Paediatrics 1985; 75: 569–574.
Celsi G, Wang Z-M, Akusjarvi G, Aperia A. Sensitive periods for glucorticoids’ regulation of Na+, K+ ATPase mRNA in the developing lung and kidney.Pediatr Res 1993; 33: 5–9.
Venkatesh VC, Ballard PL, Ertsey R, Iannuzzi DM. Gluco-corticoid regulation of genes for pulmonary surfactant proteins SP-B and SP-C.Am J Cell Mol Biol 1993; 8: 222–228.
Knight DB, Ligins GC, Wealthall SR. A randomized controlled trial of antepartum thyrotropin-releasing hormone and betamethasone in the prevention of respiratory disease in preterm infants.Am J Obstet Gynecol 1994; 171: 447–451.
Herrera VL, Cova T, Sassoon D, Ruiz-Opazp N. Developmental cell-specific regulation of Na+, K+ ATPase α1-, α2 and α3-isoform gene expression.Am J Physio 1994; 226: C1301-C1312.
Ervin MB, Berry LM, Ikegami Met al. Ovine fetal glucocorticoid treatment allers premature newborn renal responses to intravascular volume expansion.J Soc Gynecol Invest 1995; 2: 341.
Zanardo V, Giacobbo, Zambon Pet al. Antenatal aminophylline and steroid exposure: Effects on glomerular filtration rate and renal sodium excretion in preterm newborns.J Perinat Med 1990; 10: 283–288.
Kari MA, Hallman M, Eronenet al. Prenatal dexamethasone treatment in conjunction with rescue therapy of human surfactant: A randomized placebo-controlled multi-center study.Pediatrics 1994; 93: 730–736.
Jobe AH, Mitchell BR, Gunkel JH. Beneficial effects of the combined use of prenatal corticosteroids and postnatal surfactant on preterm infants.Am J Obstet Gynecol 1993; 168: 508–513.
Ballard PL, Ballard RA, Creasy RKet al. Plasma thyroid hormones and prolactin in premature infants and their mothers after prenatal treatment with thyrotropinreleasing hormone.Pediatr Res 1992; 32: 673–678.
Maher JE, Cliver SP, Goldenberg RLet al. The effect of corticosteroid therapy in the very prematureinfants.Am J Obstet Gynecol 1994; 170: 868–873.
Wright L, Horbar JD, Gunkel Het al. Evidence from multi-center networks on the current use and effectiveness of antenatal corticosteroids in low birth weight infants.Am J Obstet Gynecol 1995; 173: 263–269.
Leviton A, Kuban KC, Pagano Met al. Antenatal corticosteroids appear to reduce the risk of postnatal germinal matrix hemorrhage in intubated low birth weight newborns.Pediatrics 1993; 91: 1083–1088.
Garite TJ, Rumney PJ, Briggs GGet al. A randomized placebo-controlled trial of betamethasone for the prevention of respiratory distress syndrome at 24 to 28 weeks’ gestation.Am J Obstet Gynecol 1992; 166: 646–651.
Atkinson MW, Goldenberg RL, Gaudier FLel al. Maternal corticosteroid and tocolytic treatment and morbidity and mortality in very low birth weight infants.Am J Obstet Gynecol 1995; 173: 299–305.
Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants.Pediatrics 1972; 50:. 515–525.
Ryan CA, Finer NN. Antenatal corticosteroid therapy to prevent respiratory distress syndrome.J Ped 1995; 126: 317–319:
Phibbs RH, Ballard RA, Clements JAet al. Initial clinical trial of Exosurf, a protein free synthetic surfactant, for the prophylaxis and early treatment of hylaine membrane disease.Pediatrics 1991; 88: 1–9.
Bronstein JM, Godenberg RL. Practice variation in the use of corticosteroids: A comparison of eight data sets.Am J Obstet Gynecol 1995; 173: 296–298.
Leviton LC, Baker S, Hassol A, Goldenberg RL. An exploration of opinion and practice patterns affecting low use of antental corticosteroids.Am J Obstet Gynecol 1995; 1773: 312–316.
Colaborative Group on Antenatal Steroid Therapy. Effects of antenatal steroid administration on the infant: Long term follow up.J Pediatr 1984; 104: 259–267.
Shankaran S, Bauer CR, Bain Ret al. Relationship between antenatal steroid administration and grades III and IV intracranial hemorrhage in low birth weight infants.Am J Obstet Gynecol 1995; 173: 305–312.
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Rehan, V.K. Antenatal steroids: Miracle drug for preemies. Indian J Pediatr 63, 599–608 (1996). https://doi.org/10.1007/BF02730802
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DOI: https://doi.org/10.1007/BF02730802