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| Genesis Research Trust. |
Imminent
preterm labor, with no time to give antenatal corticosteroids? Still give it
says the result of a large population based study.
The interval
between steroids administration and birth varies, and so does the benefits achieved
by the preterm infant. When women at risk for preterm delivery receive antenatal
corticosteroids(ANS) 1 to 7 days before delivery, it reduces respiratory
distress syndrome by 34%, necrotizing enterocolitis by 54%, intraventricular
hemorrhage by 46%, and reduces Infant mortality by nearly 30%.
According to
recent Cochrane Review “a single course of a corticosteroids, given to the
mother in preterm labor and before the baby is born, helps to develop the
baby's lungs and reduces complications such as breathing problems.”
Use of corticosteroid
within the 24 hours’ window before delivery has been labelled as ‘partial’ or’ suboptimal’
according to Mikael Norman, MD, PhD, of Karolinska Institutet in Stockholm,
Sweden, and the lead investigator of this study.
In fact, the
latest timing of corticosteroids administration has never been investigated
till now.
But this
study “challenge current thinking about the optimal timing” of antenatal
corticosteroids and encourage “a more proactive management of women at risk for
imminent preterm birth, which may help reduce infant mortality and severe
neonatal brain injury,” said Mikael Norman.
The
Effective Perinatal Intensive Care in Europe (EPICE) study, a population-based
prospective cohort study, gathered data from 19 regions in 11 European
countries in 2011 and 2012 on 4594 singleton infants with gestational ages
between 24 and 31 weeks, without severe anomalies and unexposed to repeated
courses of ANS.
The study
also evaluated the effects of 3 other
evidence based practices: delivery in a maternity unit with appropriate level
of neonatal care; prevention of hypothermia (temperature on admission to
neonatal unit ≥36°C); surfactant used within two hours of birth or early nasal
continuous positive airway pressure.
Nearly 55%
were boys and the mean (SD) gestational age was 28.5 (2.2) weeks and mean (SD)
birth weight was 1213 (400) g.
The cohort was
divided into 4 categories depending upon the timing of corticosteroids given: no
injections (662 infants, or 14.4% of the study population), first injection at
less than 24 hours before birth (1,111 infants, or 24.2%), first injection at
the recommended 1-7 days before birth (1,871 infants, or 40.7%), and first
injection more than 7 days before birth (950 infants, or 20.7%).
The study results
show that:
Receiving
ANS at any time before delivery is associated with significant reduction in
neonatal morbidity as compared to receiving no steroids.
The largest
benefit (> 50%) was achieved in group which received them at the recommended
interval of 1-7 days before delivery.
Nearly 20%
of the infants in the study received ANS more than 7 days before and showed an
increased mortality by 40% as compared to women who received them in the
recommended window of period.
Using this
information on timing of administration and benefits derived, the investigators
created a simulation model for 661 infants who did not received any
corticosteroids. The model predicts that if these infants had received
treatment at least 3 hours before delivery, overall mortality would have
decreased by 26%; 3-5 hours before delivery, mortality would have decreased by
37%; and if received treatment at 6-12 hours before delivery it would have
decreased by 51%.
The authors
concluded that “Encouraging administration of antenatal corticosteroids when
delivery is very imminent could result in substantial survival and health gains
for very preterm infants.”
A current
project Screening to Improve Health in Very Preterm Infants in Europe (SHIPS) is
about follow-up programmes for children born preterm. The project builds on the
EPICE cohort to follow them to pick up any early problem and is currently ongoing in all the 11 countries.
