Antenatal steroids guidelines rcog

Delicate physiologic mechanisms allow for circulatory transition after birth with a resultant decrease in pulmonary vascular resistance. Failure of these mechanisms causes increased pulmonary pressures and right-to-left shunting, resulting in hypoxemia. This failure can be caused by meconium aspiration syndrome, pneumonia or sepsis, severe RDS, diaphragmatic hernia, and pulmonary hypoplasia. Severe persistent pulmonary hypertension of the newborn (PPHN) occurs in two out of 1,000 live births. 50 Risk factors include maternal diabetes, cesarean delivery, maternal obesity, and black race. Maternal use of a selective serotonin reuptake inhibitor is associated with the condition. Data show only a small absolute risk. 51

The researchers found that 35 percent of neonates were born to women receiving antenatal corticosteroids . Antenatal corticosteroids were not associated with reduced incidence of RDS (27 versus 17 percent; adjusted relative risk [aRR], ; 95 percent confidence interval [CI], to ) or with composite neonatal morbidity (29 versus 20 percent; aRR, ; 95 percent CI, to ). Increased rates of neonatal intensive care unit admissions (78 versus 59 percent; aRR, ; 95 percent CI, to ) and mechanical ventilation (23 versus 12 percent; aRR, ; 95 percent CI, to ) were seen in association with antenatal corticosteroids. Similar results were seen for RDS and neonatal morbidity in analysis focusing on 311 newborns delivered before 34 weeks of gestation.

Recent data also suggest that betamethasone can be beneficial in pregnant women at high risk of late preterm birth, between 34 0/7 weeks and 36 6/7 weeks of gestation who have not received a prior course of antenatal corticosteroids. The Maternal Fetal Medicine Units (MFMU) Network Antenatal Late Preterm Steroids trial ( 24 ) was a double-blind, placebo-controlled, randomized clinical trial designed to evaluate the use of antenatal betamethasone for pregnant women at high risk of delivery in the late preterm period. Women were identified to be at high risk if they presented in preterm labor, had preterm PROM, or if they had a planned delivery in the late preterm period, with the indication at the discretion of the obstetrician–gynecologist or other health care provider. Tocolysis was not employed as a part of this trial, and delivery was not delayed for obstetric or medical indications. The study found that the administration of betamethasone led to a significant decrease in the primary outcome, which was the need for respiratory support. A larger decrease was demonstrated for severe respiratory complications, from % in the placebo group to % in the betamethasone group (RR, ; 95% CI, –; P <.001). There were also significant decreases in the rates of transient tachypnea of the newborn; bronchopulmonary dysplasia; a composite of respiratory distress syndrome (RDS), transient tachypnea of the newborn and RDS; and the need for postnatal surfactant. Infants exposed to betamethasone were less likely to require immediate postnatal resuscitation. There was no increase in proven neonatal sepsis, chorioamnionitis, or endometritis with late preterm betamethasone. Hypoglycemia was more common in the infants exposed to betamethasone % versus % (RR, ; 95% CI, –); however, there were no reported adverse events related to hypoglycemia, which was not associated with an increased length of hospital stay. The rates of hypoglycemia found in the trial are similar to what is reported in the general population of late preterm infants ( 25 ). Although not studied in this trial, long-term adverse outcomes of prolonged and persistent neonatal hypoglycemia have been described ( 26 , 27 ). In order to reduce this risk and achieve the benefits of betamethasone therapy for fetal maturity in late preterm pregnancies, the American Academy of Pediatrics’ guidelines should be followed when employing this therapy (27). The American Academy of Pediatrics recommends the monitoring of neonatal blood sugars for late preterm infants because late preterm birth is a known risk factor for hypoglycemia. A single course of betamethasone is recommended for pregnant women between 34 0/7 weeks and 36 6/7 weeks of gestation at risk of preterm birth within 7 days, and who have not received a previous course of antenatal corticosteroids (24, 28 ).

Infants in the betamethasone group were more likely to have low blood sugar than those in the placebo group (24 percent vs. percent). Therefore, the data support the monitoring of neonatal blood sugar levels when steroids are given in this situation.  Overall, betamethasone administration for women at risk for late preterm delivery decreased the rate of respiratory complications in their infants. Although the drug increased the risk of low blood sugar in the infants, there were no other differences in complication rates between infants or their mothers.

Influenza Vaccine is now offered to all children aged from 2 to 11 years old. The vaccine is for all children in this age group regardless of whether they are healthy or have underlying illnesses. The vaccine is called Fluenz. It is very effective in preventing influenza and in preventing transmission of influenza in children to adults. The vaccine is given by spraying a tiny amount of liquid into each nostril. No injection is necessary. The School Health Service will arrange for the flu vaccine to be administered during school term   (age 4 to 11yrs).

If that is a real effect of the antenatal steroids, I am not sure what the mechanism would be, I wouldn’t have thought that 30 hours of antenatal steroids would be enough to induce hyperinsulinism in the babies, but I do think this is a serious potential hazard of the steroids in this group. Almost all of the control babies recovered from their respiratory distress without a significant complication, so if the hypoglycemia had long-term consequences in some babies then the balance of benefits and adverse effects might not be positive.

Antenatal steroids guidelines rcog

antenatal steroids guidelines rcog

Infants in the betamethasone group were more likely to have low blood sugar than those in the placebo group (24 percent vs. percent). Therefore, the data support the monitoring of neonatal blood sugar levels when steroids are given in this situation.  Overall, betamethasone administration for women at risk for late preterm delivery decreased the rate of respiratory complications in their infants. Although the drug increased the risk of low blood sugar in the infants, there were no other differences in complication rates between infants or their mothers.

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