2-006 | Additional Comments | Previous Article | Next Article | List of Articles | Submit Comments | Index | FSN Home Page
Antenatal Steroids and CLD
Antenatal Glucocorticoid Treatment Does Not Reduce Chronic Lung Disease in Surviving Preterm Infants. Van Marter LJ, Allred EN, Leviton A, et al. J Pediatr Feb 2001; 138:198-204.
To evaluate the hypothesis that maternal antenatal glucocorticoid treatment (AGT) not only reduces the risk of surfactant deficiency, but also reduces the risk of chronic lung disease (CLD) in surviving premature infants, a case-reference study was performed. The study population consisted of 1454 VLBW infants born at 4 university medical centers between January 1991 and December 1993. Rates of AGT varied among the centers (11% - 69%), as did the rates of CLD (defined as requirement for supplemental oxygen at 36 weeks PMA) (4% - 21%). CLD rates at each center, however, did not vary with the rate of AGT exposure. In a multivariate regression analysis, AGT did not contribute significantly to CLD risk.
Comment. It appears that the risk of CLD is less dependent on pulmonary maturity or surfactant sufficiency at birth, and more related to whether we use intubation and mechanical ventilation vs nasal CPAP for respiratory support (see previous article by Van Marter et al on risk factors for CLD (Pediatrics 2000; 105:1194-1201) reviewed in Vol 1, Issue 4 of this publication). There remains many unanswered questions about the safety of glucocoid use in preterm babies (either during the antenatal or neonatal period). Nevertheless, the beneficial effects of AGT are well documented. These include improved perinatal survival, and decreased rates of RDS, PDA, IVH, and NEC. The failure to AGT to reduce CLD in this population should not dissuade us from taking advantage of these other beneficial effects.
Date: 15 Jul 2004
Time: 15:42:13
In light of rect information-I wonder which steroid dexamethaosne or
betamethasone, was used in the subjetcs of the Van Marter paper, partcularly in
light of a recent paper.
Jobe AH, Soll RF.Choice and and dose of corticosteroid for antenatal treatments.
Am J Obstet Gynecol. 2004 Apr;190(4):878-81. Review.
UserName: Dennis Costakos
Institution: FSH Mayo, LaCrosse and Mayo College of Medicine
telephone: 608 785-0940
email: costakos.dennis@mayo.edu
Additional Comments: You may add your own comments to the discussion of this topic by selecting : Submit Comments.