The optimal scheme for antenatal prevention of respiratory disorders in preterm neonates born to mothers with placenta increta determined
08.02.2024
09:32
Researchers have determined when to administer corticosteroids to patients with placenta increta to most effectively reduce the risk of neonatal respiratory distress syndrome (RDS). Courses of antenatal prevention were administered between 34/0 and 36/6 weeks of gestation before early delivery due to placenta increta. Results of a study conducted by researchers from Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology and I.M. Sechenov First Moscow State Medical University were published in the first issue 2024 of the journal of Obstetrics and Gynecology.
This prospective comparative cohort study included 226 late preterm neonates born to mothers with placenta increta. Group 1 (study group, n=80) included children whose mothers received a full course of RDS prevention within seven days before delivery. Group 2 (control group, n=146) consisted of children born to mothers who had received antenatal RDS prevention > 7 days before delivery.
Furthermore, the children were divided into four subgroups:
1A (n=42) included children whose mothers received a single course of RDS prevention no more than seven days before delivery;
1B (n=35) included children whose mothers received two courses of RDS prevention, one of which was no more than seven days before delivery;
2A (n=97) and 2B (n=45) represented children whose mothers received RDS prevention more than seven days before delivery once and twice, respectively.
Antenatal RDS prevention was performed according to the current clinical guidelines, namely, dexamethasone at a dose of 8 mg intramuscularly three times with an injection interval of 8 h (total dose of 24 mg)
The analyzed parameters included gestational age of the newborns, their birth and height, sex, Apgar score at 1 and 5 minutes, and frequency of neonatal respiratory therapy, that is, invasive mechanical ventilation and non-invasive respiratory support, including high-frequency oscillatory ventilation (HFOV).
Researchers have also studied the maximum required mean airway pressure, frequency and duration of supplemental oxygen delivery, frequency of surfactant therapy and neonatal hypoglycemia, length of stay in the NICU, and total length of infant hospitalization.
The study findings showed that infants born to mothers with placenta increta who were given RDS prevention seven days before birth were:
- 1.6 times less likely to require intubation and invasive respiratory therapy (RR [95%CI] 0.62 [0.39; 0.96]),
- 1.8 times less likely to require HFOV (RR [95%CI] 0.57 [0.35;0.93]),
- 1.7 times less likely to require supplemental oxygen (RR [95%CI], 0.59 [0.39;0.87]).
The required oxygen concentration in this group was significantly lower, and there was a significantly shorter total duration of respiratory support and shorter length of stay in the NICU. There were no significant benefits of increasing the frequency of the courses.
The authors of this article are confident that antenatal RDS prevention during the last 7 days before delivery is effective in reducing the severity of respiratory disorders in late preterm infants of 34/0-36/6 weeks of gestational age born to mothers with placenta increta. The course of RDS prevention in the earlier stages of pregnancy is not decisive, and in patients with placenta increta, an additional course is required during the week before planned delivery.
