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Promoting pulmonary maturity 

Promoting pulmonary maturity
Chapter:
Promoting pulmonary maturity
Author(s):

Murray Enkin

, Marc J. N. C. Keirse

, James Neilson

, Caroline Crowther

, Lelia Duley

, Ellen Hodnett

, and Justus Hofmeyr

DOI:
10.1093/med/9780192631732.003.0025
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date: 23 October 2019

Prenatal treatment with 24 mg betamethasone, or 24 mg dexamethasone, for lung maturation, is associated with a significant reduction in the risk of respiratory distress syndrome in preterm infants. This reduction is independent of gender, and applies to babies born at all gestational ages at which respiratory distress syndrome may occur. It is accompanied by reductions in the risk of periventricular hemorrhage, lower neonatal mortality rate, and in a reduced cost and duration of neonatal care. These benefits are achieved without any detectable increase in the risk of maternal, fetal, or neonatal infection. Although maternal infection is increased in women with rupture of membranes for more than 24 hours prior to birth, prenatal corticosteroid administration does not increase the risk of stillbirth. Every effort should be made to treat women with corticosteroids prior to preterm birth, either as a result of preterm labor or planned elective preterm birth. The only possible exception is for women with diabetes. Treatment should commence at presentation in women with any symptoms or signs that suggest the onset of preterm labor or indicate a potential need for elective preterm birth in the near future. Treatment should not be withheld because birth appears imminent. There are no controlled data to recommend or refute the widespread use of repeat doses of prenatal corticosteroids for women who remain at risk of preterm birth but undelivered after an initial course. Until the results from the trials currently in progress are available, multiple doses of prenatal corticosteroids should be avoided. TRH should not be used for the promotion of pulmonary maturation.

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