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Fetal betamethasone treatment and neonatal outcome in preeclampsia and intrauterine growth restriction

2003; Elsevier BV; Volume: 189; Issue: 6 Linguagem: Inglês

10.1016/s0002-9378(03)00923-2

1097-6868

István Szabó, Miklós Vizer, Tibor Ertl,

Birth, Development, and Health

To the Editors: We were interested to read the article of Jobe et al.1.Jobe A.H. Newnham J.P. Moss T.J. Ikegami M. Differential effects of maternal betamethasone and cortisol on lung maturation and growth in fetal sheep.Am J Obstet Gynecol. 2003; 188: 22-28Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar This study demonstrated that fetal betamethasone treatment induced lung maturation without apparent effect on fetal growth. In human preterm infants, repeated maternal antenatal corticosteroid (ANCS) therapy resulted in intrauterine growth restriction (IUGR).2.French N.P. Hagan R. Evans S.F. Godfrey M. Newnham J.P. Repeated antenatal corticosteroids: size at birth and subsequent development.Am J Obstet Gynecol. 1999; 180: 114-121Abstract Full Text Full Text PDF PubMed Scopus (505) Google Scholar Maternal ANCS and postnatal surfactant administration are still the mainstays for the prevention and therapy of respiratory distress syndrome (RDS). According to the guidelines of the EURAIL working group (Europe Against Immature Lung) maternal ANCS treatment is indicated between the 26th and 34th weeks of pregnancy for the prevention of RDS.3.Visser G.H.A. Anceschi M.M. Guidelines on antepartum corticosteroids.Prenat Neonat Med. 2001; 6: 368-370Google Scholar ANCS administration is effective if delivery occurs at least 24 hours after the first dose was given. Recent data suggest that in pregnancies complicated with preeclampsia (PE) and/or IUGR the incidence of RDS is not decreased; moreover, the effectiveness of ANCS is a controversial issue.4.Elimian A. Verma U. Canterino J. Shah J. Visintainer P. Tejani N. Effectiveness of antenatal steroids in obstetric subgroups.Obstet Gynecol. 1999; 93: 174-179Crossref PubMed Scopus (90) Google Scholar We analyzed the perinatal data of 60 neonates born to mothers with severe PE and/or IUGR between the 24th and 32nd weeks of gestation from May 1, 1996, to December 31, 2002, at our perinatal unit. All fetuses were treated with a single intramuscular injection of betamethasone in a dose of 0.5 mg/kg estimated fetal weight for the prophylaxis of RDS because termination of pregnancy for combined maternal/fetal interest was inevitable and fetal lung maturity tests showed immature index values. Mean gestational age at birth and birth weight were 29.7±2.2 weeks and 1125±302 g, respectively. One- and 5-minute Apgar scores were 7.5±1.4 and 9.0±1.0. The mean time interval between fetal intervention and delivery was 2.1 days (range 0.1-27 days). The incidences of RDS and intraventricular hemorrhage were 35.0% (n = 21) and 20.0% (n = 12), respectively. Thirty newborn infants (50.0%) required ventilatory support for an average of 7.1 days (range 0.7-31 days). Bronchopulmonary dysplasia developed in 3 neonates (5.0%). Ophthalmologic examination revealed six cases of retinopathy of prematurity (10.0%). Eight extremely-low-birth-weight infants were lost (mean gestational age 25.6±1.7 weeks, birth weight 755±230 g), giving a 28-day survival rate of 86.7%. Our preliminary data suggest that single direct fetal intramuscular betamethasone treatment between the 24th and 32nd weeks of gestation is a promising novel method for the prophylaxis of RDS in high-risk pregnancies.