This study was undertaken to determine whether the benefits of a single course of antenatal steroid treatment for neonatal respiratory morbidity diminish beyond 7 days. Study design: A retrospective chart review was p...This study was undertaken to determine whether the benefits of a single course of antenatal steroid treatment for neonatal respiratory morbidity diminish beyond 7 days. Study design: A retrospective chart review was performed of all deliveries less than 34 weeks’ gestation where delivery occurred after completing a single course of antenatal steroids (dexamethasone or betamethasone). Maternal and neonatal charts were reviewed, treatment course was confirmed, and neonatal morbidities were collected. Results: Of 197 neonates whose mothers received a full course of antenatal steroids, 98 delivered within 7 days and 99 delivered more than 7 days after the initial dose. The 2 groups were similar in gestational age at delivery (30 weeks 0 days vs 30 weeks 4 days). The groups were also similar in maternal age, race, payor status, type of steroid given, route of delivery, gender, and birth weight. Overall, infants delivering within 7 days had a lower incidence of receiving respiratory support for more than 24 hours (62% vs 81% , P < .01), but there were no significant differences between the groups in surfactant treatment (39% vs 47% ), use of mechanical ventilation (49% vs 59% ), necrotizing enterocolitis (6% vs 4% ), intraventricular hemorrhage (15% vs 20% ), oxygen dependence at 28 days (24% vs 23% ) or at 36 weeks estimated gestational age (13% vs 12% ), length of stay (34 days vs 38 days), or mortality (2 vs 0). These results were no different when evaluating only infants delivered before 30 weeks. Conclusion: Among infants exposed to a single course of antenatal steroids, delivering more than 7 days after initiation of treatment was associated with an increased need for short-term respiratory support, but not other measures of neonatal morbidity. These data challenge the concept of diminishing efficacy of steroids after 7 days, and question the need for considering a rescue course.展开更多
Objective: To evaluate the effectiveness of fluid supplementation in decreasing the rate of exchange transfusion and the duration of phototherapy in term neonates with severe nonhemolytic hyperbilirubinemia. Study des...Objective: To evaluate the effectiveness of fluid supplementation in decreasing the rate of exchange transfusion and the duration of phototherapy in term neonates with severe nonhemolytic hyperbilirubinemia. Study design: This was a randomized controlled trial conducted in a tertiary care referral unit in northern India. Seventy-four term neonates with severe nonhemolytic hyperbilirubinemia (total serum bilirubin > 18 mgdL 308 μmolL to < 25 mgdL 427 μmolL ). The subjects were randomized to an “extra fluids”group (intravenous fluid supplementation for 8 hours and oral supplementation for the duration of phototherapy; n = 37) or a control group (n = 37). Results: At inclusion, 54 infants (73%) had high serum osmolality, including 28 (75%) in the extra fluids group and 26 (70%) in the control group. The proportion of infants who underwent exchange transfusion was lower in the extra fluids group than in the control group: 6 (16%) versus 20 (54%)(P = .001; relative risk = 0.30; 95%confidence interval = 0.14 to 0.66). The duration of phototherapy was also shorter in the extra fluids group: 52 ±18 hours versus 73 ±31 hours (P = .004). Conclusion: Fluid supplementation in term neonates presenting with severe hyperbilirubinemia decreased the rate of exchange transfusion and duration of phototherapy.展开更多
文摘This study was undertaken to determine whether the benefits of a single course of antenatal steroid treatment for neonatal respiratory morbidity diminish beyond 7 days. Study design: A retrospective chart review was performed of all deliveries less than 34 weeks’ gestation where delivery occurred after completing a single course of antenatal steroids (dexamethasone or betamethasone). Maternal and neonatal charts were reviewed, treatment course was confirmed, and neonatal morbidities were collected. Results: Of 197 neonates whose mothers received a full course of antenatal steroids, 98 delivered within 7 days and 99 delivered more than 7 days after the initial dose. The 2 groups were similar in gestational age at delivery (30 weeks 0 days vs 30 weeks 4 days). The groups were also similar in maternal age, race, payor status, type of steroid given, route of delivery, gender, and birth weight. Overall, infants delivering within 7 days had a lower incidence of receiving respiratory support for more than 24 hours (62% vs 81% , P < .01), but there were no significant differences between the groups in surfactant treatment (39% vs 47% ), use of mechanical ventilation (49% vs 59% ), necrotizing enterocolitis (6% vs 4% ), intraventricular hemorrhage (15% vs 20% ), oxygen dependence at 28 days (24% vs 23% ) or at 36 weeks estimated gestational age (13% vs 12% ), length of stay (34 days vs 38 days), or mortality (2 vs 0). These results were no different when evaluating only infants delivered before 30 weeks. Conclusion: Among infants exposed to a single course of antenatal steroids, delivering more than 7 days after initiation of treatment was associated with an increased need for short-term respiratory support, but not other measures of neonatal morbidity. These data challenge the concept of diminishing efficacy of steroids after 7 days, and question the need for considering a rescue course.
文摘Objective: To evaluate the effectiveness of fluid supplementation in decreasing the rate of exchange transfusion and the duration of phototherapy in term neonates with severe nonhemolytic hyperbilirubinemia. Study design: This was a randomized controlled trial conducted in a tertiary care referral unit in northern India. Seventy-four term neonates with severe nonhemolytic hyperbilirubinemia (total serum bilirubin > 18 mgdL 308 μmolL to < 25 mgdL 427 μmolL ). The subjects were randomized to an “extra fluids”group (intravenous fluid supplementation for 8 hours and oral supplementation for the duration of phototherapy; n = 37) or a control group (n = 37). Results: At inclusion, 54 infants (73%) had high serum osmolality, including 28 (75%) in the extra fluids group and 26 (70%) in the control group. The proportion of infants who underwent exchange transfusion was lower in the extra fluids group than in the control group: 6 (16%) versus 20 (54%)(P = .001; relative risk = 0.30; 95%confidence interval = 0.14 to 0.66). The duration of phototherapy was also shorter in the extra fluids group: 52 ±18 hours versus 73 ±31 hours (P = .004). Conclusion: Fluid supplementation in term neonates presenting with severe hyperbilirubinemia decreased the rate of exchange transfusion and duration of phototherapy.
