Fibroblast-Pneumonocyte Factor
Jason Kelley in Cytokines of the Lung, 2022
Significant quantities of surfactant are not synthesized until close to term. The fine regulation of this quantitative progression in expression of phenotype (e.g., when the fetus is threatened with premature birth) is under multihormonal control (Smith, 1979a, 1984), yet local cell and tissue interactions continue to modulate the endocrine signals. A central role is played by endogenous fetal glucocorticoids. This physiological function has been reviewed (Smith, 1984), and evidence for it has been strengthened by observations that the antiglucocorticoid RU486 delays fetal lung maturation when administered to the dam (Guettari et al., 1989) and by observations that lung maturation is delayed in mice with H-2 (HLA) phenotypes associated with low expression of glucocorticoid receptors (Honig et al., 1984). The use of synthetic steroids antenatally in the prevention of respiratory distress syndrome (Collaborative Group on Antenatal Steroid Therapy, 1981; Liggins and Howie, 1972; Taeusch et al., 1979) represents a pharmacologic attempt to trigger the physiological responses precociously.
Pregnancy and neurotrauma
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
Corticosteroids such as dexamethasone are frequently administered when neuropathology, especially brain tumors, is present in order to reduce edema and control elevated ICP. High dose and chronic administration of prenatal dexamethasone has been implicated in potential adverse fetal affects including abnormal skeletal growth, cleft palate, and adrenal hypoplasia.22 However, single dose antenatal steroid administration in premature infants has been shown to result in improved neuro-developmental outcomes and a single dose of antenatal corticosteroids is recommended by the ACOG for fetal lung maturation in the setting of prematurity.23 Overall, the administration of single dose dexamethasone to the pregnant patient undergoing neurosurgical intervention is likely to be safe and is advocated by multiple groups.18,24 Similar to diuretics, corticosteroids should be administered when the benefits outweigh the risks, and at the lowest possible therapeutic dose.
Preterm labour
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
Most worrying is the increased risk of neonatal death seen when three or more courses of antenatal steroids were given in the American TRH Study.19 Any extensions to the accepted gestational window should also be made cautiously. There may be limited steroid responsiveness in fetuses at or below 25 weeks’ gestation. As there is little proof that steroids are beneficial, their use may lead to overoptimism. Although RCOG’s Green-top guideline Antenatal Corticosteroids to Reduce Neonatal Morbidity and Mortality (2010) recommends steroids from 24 weeks’ gestation, this recommendation is not based on evidence from randomised trials. More worryingly, using steroids when inappropriate may hinder later use, particularly when clinicians are wary of multiple courses. The upper gestation at which steroids should be used is also controversial. In comparison to PPROM and preterm labour, elective caesarean deliveries after 34 weeks are at increased risk of respiratory difficulties and administration of prophylactic steroids has been shown to reduce the risk of neonatal unit admission for babies born by caesarean section before 39 weeks of gestation [A]. In addition, there is some evidence that growth-restricted fetuses may derive benefit from antenatal steroid administration up to the 36th week of gestation [C] if planned late preterm birth is indicated.
Abnormal Umblical Artery Doppler is Utilized for Fetuses with Intrauterine Growth Restriction Birth at 280/7–336/7 Gestational Weeks
Published in Fetal and Pediatric Pathology, 2020
Emre Baser, Istemi Han Celik, Melek Bilge, Taner Kasapoglu, Dilek Ulubas Isik, Ethem Serdar Yalvac, Omer Lutfi Tapisiz, Safak Ozdemirci
The total rate of respiratory disorders in the AREDF group was higher than that of the NEDF group, though definitive diagnosis of respiratory morbidities, such as RDS, pneumothorax, mechanical intubation, pulmonary hypertension and surfactant use, was similar between the two groups, despite the lower GA and BW in the AREDF group. This finding may be explained by the small size of our study. This may be associated with higher antenatal steroid use in the AREDF group. It is well known that antenatal steroid use at 24–34 gestational weeks promotes fetal lung maturation and reduces respiratory and neurologic morbidities, as well as mortality [11]. BPD was found to be increased in patients with AREDF [12]. However, better antenatal care, antenatal steroids and noninvasive NICU protocols may lead to the decreased negative effects of AREDF on BPD in our study group. Another finding of our study was that the feeding intolerance in AREDF group was significantly higher than that in the NEDF group. Similar to the results obtained in our research, studies have reported that feeding intolerance and NEC were more common in newborns with absent or reversal of end‐diastolic flow [13, 14]. These may be associated with in-utero-decreased intestinal perfusion due to shunting of blood in response to hypoxia to vital organs, including heart, brain and adrenals, focal ischemia, and hypoperistalsis [15]. A higher antenatal magnesium application rate in this group may also have played a role in feeding intolerance due to the effect of decreasing intestinal transit time [16–18].
Incidence, Risk Factors and Screening Evaluation of Retinopathy of Prematurity in High Birthweight Infants: A Large Cohort Study in Turkey
Published in Ophthalmic Epidemiology, 2022
Volkan Dericioğlu, Sedat Butur, Hande Celiker, Özlem Şahin
This study revealed a highly significant protective effect of antenatal steroid therapy in ROP development (p < .001). Although there are different results about the protective effect of antenatal steroid administration, a meta-analysis that included 28 studies in 2018 has shown that antenatal steroid administration is associated with reduced risk of ROP development and progression to severe ROP.23 Furthermore, a Cochrane review revealed that in addition to the mortality rate, the risk of severe complications and the need for respiratory support is also reduced by antenatal steroid administration.24 However, the positive effects of antenatal steroid could not be demonstrated in infants with a GA below 28 weeks.25 The authors speculated that “the effect of corticosteroids on the maturation of the alveoli might differ depending on the GA at exposure, considering that the alveoli develop from 28 to 35 weeks’ gestation”.25 As a result, a highly significant protective effect revealed in our study could be explained by a more mature population of this study. In future prospective studies, the impact of antenatal steroid administration on ROP development in more mature infants can be investigated.
Preterm and term preeclampsia: differences in biochemical parameter and pregnancy outcomes
Published in Postgraduate Medicine, 2018
If disease onset is early, in the absence of an indication for immediate delivery, expectant management with careful control of blood pressure and monitoring of fetal wellbeing is given to patients according to the standardized protocol. This comprised a close follow-up of the maternal status, intermittent fetal heart rate monitoring, and blood analysis. Tocolysis and antenatal steroid administration are the usual practice. In our hospital, beside antihypertensive therapy, pregnant women were received dexamethasone therapy for fetal lung maturity. Two doses of 6 mg were given intramuscularly 12 h apart for 2 days. Prolongation of the pregnancy at early gestations is purely to confer benefit for the fetus and reduce complications associated with prematurity as definitive treatment remains delivery of the baby. The neonate is likely to benefit from a prolongation of pregnancy because of the sequela of prematurity, although a compromised intrauterine environment might jeopardize this advantage [17].
Related Knowledge Centers
- Betamethasone
- Chorioamnionitis
- Endometritis
- Infant Respiratory Distress Syndrome
- Randomized Controlled Trial
- Corticosteroid
- Preterm Birth
- Medication
- Intraventricular Hemorrhage
- Necrotizing Enterocolitis