Antenatal corticosteroids and prevention of respiratory distress in the premature newborn: Usefulness of rescue treatment

The effectiveness of antenatal corticosteroid therapy for foetal lung maturation in pre-term infants is well known, but there is uncertainty about the time that the treatment remains effective. A descriptive, longitudinal study was conducted to determine whether the need for surfactant administration was determined by the time-lapse between corticosteroids administration and delivery, and when repeating the doses of maternal corticosteroids should be considered. A total of 91 premature infants ≤32 weeks and/or ≤1500 g (limit 34 + 6 weeks) whose mothers had received a complete course of corticosteroids were included. In patients at 27–34 + 6 weeks, we found that the longer the time elapsed between delivery and administration of corticosteroids, the more likely the babies were to require treatment with surfactant (p = 0.027). The resulting ROC curve determined an 8-days cut-off after which repeating a dose of corticosteroids should be assessed.

ResumenAunque se conoce la efectividad de la corticoterapia materna para la maduración pulmonar foetal en prematuros, no hay seguridad acerca del tiempo en que el tratamiento continúa siendo efectivo. Realizamos un estudio descriptivo y longitudinal, para relacionar el tiempo transcurrido desde la administración de glucocorticoides maternos, y la necesidad o no de surfactante, y a partir de qué punto se debería considerar la repetición de las dosis de corticoides maternos. Se incluyeron 91 prematuros de ≤32 semanas y/o ≤1.500 g (límite 34 + 6 semanas) cuyas madres habían recibido una pauta completa de corticoides. En los pacientes de 27-34 + 6 semanas, comprobamos que a mayor tiempo transcurrido entre el parto y la administración de corticoides, mayor probabilidad de necesitar tratamiento con surfactante (p = 0,027). La curva ROC calculada determinó un punto de corte de 8 días a partir del cual debería valorarse el repetir la dosis de corticoide.