The role of prenatal corticotherapy in the better outcome of the respiratory distress

syndrome, including complications

Author: Nagy Iulia Andrea

Coordinator: Simon Márta, PhD, Lecturer

Coauthor: Ortopan Maria, Oana Andrea Edina

Newborn respiratory distress syndrome

PREMATURITY< 37 weeks of gestation

Lack of SURFACTANT synthesis

Immature Type II Pneumocytes

Alveolar collapse

V/Q Mismatch

HYPOXEMIA

HYPERCARBIA

CYANOSIS

RESPIRATORY AND METABOLIC ACIDOSIS

DEATH

Newborn respiratory distress syndrome

Corticosteroids administered to women at risk of preterm delivery will cross blood placental barrier and help enhancing fetal lung maturation

Steroids used are usually:

Treatment is given IM

Antenatal CORTICOTHERAPY

•Dexamethasone (6 mg) -4 doses 12 hrs apart

•Betamethasone (12 mg) -2 doses 24 hrs apart

Antenatal Corticosteroid apart from reducing RDS severity also reduce:

Complications, among preterm infants

Intrahospital mortality

Antenatal CORTICOTHERAPY

Objectives to determine the benefits of antenatal

corticosteroids in leading to better

outcomes in preterm infants

Material and Method: retrospective observational study

219 premature babies of 24-36 weeks, with

RDS, treated in Mures Country NICU

between 2012-2013

Newborns were divided into two groups:

group 1-  babie whose mothers

received

corticosteroids

group 2- babies with no prophylactic

corticotherapy.

APGAR score Group 1 (n=107)

Group 2 (n=112)

P -value

1st minute 7.35 6.38 0.0005

5th minute 8.23 7.57 0.0012

RESULTS:

Group 1 Group 2 P-value

Total stay in hospital (days)

29.27* 4 deaths

22.95* 12 deaths

0.0081

Mean Apgar score at 1 and 5 minutes after birth in:group 1- newborns exposed to ACS and group 2- newborns without ACS

Mean length of hospital stay in the two groups

Percentage of antenatal corticotherapy

RESULTS:

Antenatal exposure at

corticosteroids

No of pregnancies

%

YES 107 48,9%

NO 112 51,1%

Total 219 100 %

About 51 % of the women couldn’t get ACS

Frequency of RDS forms group 1 vs. group 2

mild RDS moderate /severe RDS

0.00

10.00

20.00

30.00

40.00

50.00

60.0055.1

47.0644.9

52.94

Exposed to ACS

No ACS

%

P > 0.05

< 28 28 - 31 32 - 360

5

10

15

20

25

30

35

40

45

50

9 9

65

43

35

ACS - MV

ACS - No MV

Weeks gestation

No of cases

Need for mechanical ventilation in infants of different gestational ages

CORTICOTHERAPY MECHANICAL VENTILATION

TOTAL

YES NO

YES 9

42.9 %

43

69.4 %

52

62.7 %

NO 12

57.1 %

19

30.6 %

31

37.3 %

TOTAL 21

100 %

62

100 %

83

100 %

Need for mechanical ventilation in group of moderate preterm infants 28-31 weeks of gestation

P =0.03

CORTICOTHERAPY IVH TOTAL

YES NO

YES 8

36.4 %

31

63.3 %

39

54.9%

NO 14

63.6 %

18

36.7 %

32

45.1 %

TOTAL 22

100 %

49

100 %

71

100%

Intraventricular Hemorrhage in preterm infants with BW < 1500 g

P= 0.03

CORTICOTHERAPY No. of NEONATAL DEATHS

TOTAL

YES NO

YES 4

25 %

103

50.7 %

107

48.9%

NO 12

75 %

100

49.3 %

112

51.1%

TOTAL 16

100 %

203

100%

219

100 %

Neonatal mortality

P= 0.04

Prenatal corticotherapy was associated with clinical outcome improvements in neonates with RDS

We found statistically significant correlations (p<0.05) between antenatal exposure at corticosteroids and :

a higher APGAR score a decreased need for mechanical ventilation in

moderate preterm infants A reduced risk of IVH, in infants with BW <1500

g A lower rate of neonatal mortality

CONCLUSIONS:

THANK YOU !