Effectiveness of antenatal prevention of respiratory distress syndrome
AbstractAim. The main problem of a premature newborn is lung immaturity, which contributes to the development of fetal respiratory distress syndrome (RDS). The current consensus on its antenatal prevention prescribes administration of glucocorticoids to pregnant women with a high probability of giving birth between the 24th and 34th weeks of gestation.
However, prevention of fetal RDS raises doubts about its effectiveness and safety. In recent decades, in economically developed countries, exogenous surfactant has become widely used for the treatment of RDS, which has reduced mortality rate of premature infants from it, and made the need for prevention less obvious.
Results. We did not receive evidences of the efficiency for the prevention of the fetals RDS. Premature infants who mothers got full course of glucocorticoids during pregnancy required a respiratory support after delivery with the same frequency and duration as premature infants who mothers did not get this course.
Conclusion. We tried to evaluate the effectiveness of preventing fetal RDS in gestational age 24–34 weeks, by comparing the course of neonatal period in 240 premature infants born after an antenatal course of glucocorticoids, with the same period in 125 premature infants born at the same gestational age, but without previous prevention.
Keywords:antenatal prevention of fetal respiratory distress syndrome; premature birth; prematurity
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
Contribution. Writing the article, correcting the article – Knyazev S.A., Fatkullina L.S., Andreeva A.D.; data collection – Andreeva A.D., Magomedbekova Z.A.; statistical data processing – Andreeva A.D.; approval of the final version for publication – Knyazev S.A., Fatkullina L.S.
For citation: Knyazev S.A., Andreeva A.D., Magomedbekova Z.A., Fatkullina L.S. Effectiveness of antenatal prevention of respiratory distress syndrome. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2024; 12. Supplement: 30–3. DOI: https://doi.org/10.33029/2303-9698-2024-12-suppl-30-33 (in Russian)
REFERENCES
1. Busada J.T., Cidlowski J.A. Mechanisms of glucocorticoid action during development. Curr Top Dev Biol. 2017; 125: 147–70. DOI: https://doi.org/10.1016/bs.ctdb.2016.12.004
2. Reynolds L.A., Tansey E.M. (eds). Prenatal Corticosteroids for Reducing Morbidity and Mortality after Preterm Birth. Wellcome Witnesses to Twentieth Century Medicine. Vol. 25. London: Wellcome Trust Centre for the History of Medicine at UCL, 2005. URL: http://www.histmodbiomed.org/sites/default/files/44848.pdf
3. Kemp M.W., Jobe A.H., Usuda H., et al. Efficacy and safety of antenatal steroids. Am J Physiol Regul Integr Comp Physiol. 2018; 315 (4): 825–39. DOI: https://doi.org/10.1152/ajpregu.00193.2017
4. McLaughlin K.J., Crowther C.A., Walker N., Harding J.E. Effects of a single course of corticosteroids given more than 7 days before birth: a systematic review. J Obstet Gynaecol. 2003; 43 (2): 101–6. DOI: https://doi.org/10.1046/j.0004-8666.2003.00052.x PMID: 14712961.
5. Davis E.P., Waffarn F., Uy C., Hobel C.J., Glynn L.M., Sandman C.A. Effect of prenatal glucocorticoid treatment on size at birth among infants born at term gestation. J Perinatol. 2009; 29: 731–37. DOI: https://doi.org/10.1038/jp.2009.85
6. Alexander N., Rosenlöcher F., Stalder T., et al. Impact of antenatal synthetic glucocorticoid exposure on endocrine stress reactivity in term-born children. J Clin Endocrinol Metab. 2012; 97 (10): 3538–44. DOI: https://doi.org/10.1210/jc.2012-1970
7. Dalziel S.R., Lim V.K., Lambert A., et al. Antenatal exposure to betamethasone: psychological functioning and health related quality of life 31 years after inclusion in randomised controlled trial. BMJ. 2005; 331: 665. DOI: https://doi.org/10.1136/bmj.38576.494363.E0
8. Dalziel S.R., Walker N.K., Parag V., et al. Cardiovascular risk factors after antenatal exposure to betamethasone: 30-year follow-up of a randomised controlled trial. Lancet. 2005; 365: 1856–62. DOI: https://doi.org/10.1016/S0140-6736(05)66617-2
9. Kamath B.D., Macguire E.R., McClure E.M., Goldenberg R.L., Jobe A.H. Neonatal mortality from respiratory distress syndrome: lessons for low-resource countries. Pediatrics. 2011; 127: 1139–46. DOI: https://doi.org/10.1542/peds.2010-3212
10. Kemp M., Newnham J., Challis J., Jobe A., Stock S. The clinical use of corticosteroids in pregnancy. Hum Reprod Update. 2016; 22: 240–59. DOI: https://doi.org/10.1093/humupd/dmv047