Document Detail


Antenatal treatment with corticosteroids for preterm neonates: impact on the incidence of respiratory distress syndrome and intra-hospital mortality.
MedLine Citation:
PMID:  12870049     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Although the benefits of antenatal corticosteroids have been widely demonstrated in other countries, there are few studies among Brazilian newborn infants. OBJECTIVE: To evaluate the effectiveness of antenatal corticosteroids on the incidence of respiratory distress syndrome and intra-hospital mortality among neonates with a gestational age of less than 34 weeks. TYPE OF STUDY: Cross-sectional. SETTING: A tertiary-care hospital. PARTICIPANTS: Neonates exposed to any dose of antenatal corticosteroids for fetal maturation up to 7 days before delivery, and newborns paired by sex, birth weight, gestational age and time of birth that were not exposed to antenatal corticosteroids. The sample obtained consisted of 205 exposed newborns, 205 non-exposed and 39 newborns exposed to antenatal corticosteroids for whom it was not possible to find an unexposed pair. PROCEDURES: Analysis of maternal and newborn records. MAIN MEASUREMENTS: The primary clinical outcomes for the two groups were compared: the incidence of respiratory distress syndrome and intra-hospital mortality; as well as secondary outcomes related to neonatal morbidity. RESULTS: Antenatal corticosteroids reduced the occurrence of respiratory distress syndrome (OR: 0.33; 95% CI: 0.21-0.51) and the protective effect persisted when adjusted for weight, gestational age and the presence of asphyxia (adjusted OR: 0.27; 95% CI: 0.17-0.43). The protective effect could also be detected through the reduction in the need for and number of doses of exogenous surfactant utilized and the number of days of mechanical ventilation needed for the newborns exposed to antenatal corticosteroids. Their use also reduced the occurrence of intra-hospital deaths (OR: 0.51: 95% CI: 0.38-0.82). However, when adjusted for weight, gestational age, presence of prenatal asphyxia, respiratory distress syndrome, necrotizing enterocolitis and use of mechanical ventilation, the antenatal corticosteroids did not maintain the protective effect in relation to death. With regard to other outcomes, antenatal corticosteroids reduced the incidence of intraventricular hemorrhage grades III and IV (OR: 0.28; 95% CI: 0.10-0.77). CONCLUSIONS: Antenatal corticosteroids were effective in the reduction of morbidity and mortality among premature newborns in the population studied, and therefore their use should be stimulated within our environment.
Authors:
Joice Fabíola Meneguel; Ruth Guinsburg; Milton Harumi Miyoshi; Clovis de Araujo Peres; Regina Helena Russo; Benjamin Israel Kopelman; Luiz Camano
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Publication Detail:
Type:  Journal Article     Date:  2003-07-14
Journal Detail:
Title:  São Paulo medical journal = Revista paulista de medicina     Volume:  121     ISSN:  1516-3180     ISO Abbreviation:  Sao Paulo Med J     Publication Date:  2003 Mar 
Date Detail:
Created Date:  2003-07-18     Completed Date:  2003-08-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  100897261     Medline TA:  Sao Paulo Med J     Country:  Brazil    
Other Details:
Languages:  eng     Pagination:  45-52     Citation Subset:  IM    
Affiliation:
Departament of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, Brazil. dpn@osite.com.br
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use*
Adult
Brazil / epidemiology
Female
Hospital Mortality*
Humans
Incidence
Infant
Infant Mortality
Infant, Newborn
Infant, Premature*
Male
Pregnancy
Pregnancy Trimester, Third
Prenatal Care*
Respiratory Distress Syndrome, Newborn / epidemiology,  prevention & control*
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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