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Randomized Controlled Trial
. 2018 Jul;38(7):828-833.
doi: 10.1038/s41372-018-0124-9. Epub 2018 May 24.

The window of improved neonatal respiratory compliance after rescue antenatal steroids

Brian K Jordan  1 , Diane Schilling  2 , Cindy T McEvoy  2
Affiliations
Randomized Controlled Trial

The window of improved neonatal respiratory compliance after rescue antenatal steroids

Brian K Jordan et al. J Perinatol. 2018 Jul.

Abstract

Objective: To evaluate whether premature infants delivered ≤7 days after rescue antenatal steroid treatment (ideal treatment) have increased passive respiratory compliance compared to those delivered >7 days after treatment (remote treatment).

Methods: Secondary analysis of a randomized trial of rescue antenatal steroids on respiratory compliance. Infants in the treatment group were stratified by the interval between rescue antenatal steroids and delivery. We then compared the respiratory compliance in the ideal vs. remote groups.

Results: Forty-four women (56 infants) received rescue antenatal steroids. Forty-nine infants had evaluable respiratory compliance measurements, with 27 (GA 30.1 weeks, BW 1362 g) "ideally" treated, and 22 (GA 33.8 weeks, BW 2248 g) "remotely" treated. Respiratory compliance was significantly higher for the ideal compared to the remote group (1.32 vs. 1.06 mL/cm H2O/kg; p = 0.037).

Conclusion: Infants treated with rescue antenatal steroids have a significantly higher respiratory compliance if delivery occurs within 7 days after treatment.

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Conflict of interest statement

Conflicts of Interest – The authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of study participants.
Fig. 2
Fig. 2
Distribution of latency period in days between receipt of rescue antenatal steroids and delivery for the 49 infants with evaluable measurements of Crs.
Fig. 3
Fig. 3
a. Mean ± SEM of respiratory compliance in 27 infants who delivered ideally after a rescue course of antenatal steroids and 22 infants who delivered remotely after a rescue course of antenatal steroids; ** p<0.05 comparing ideally versus remotely treated. P value is adjusted for gestational age, rupture of membranes, maternal smoking, maternal diabetes, and multiple gestation using a linear mixed model developed on a prior analysis of this dataset b. Graph of individual respiratory compliance data following maternal administration of rescue AS. Data from 0 – 21 days following rescue AS is shown. Dashed line represents the trendline.
Fig. 4
Fig. 4
Theoretical model of the effect of the initial course and rescue course of antenatal steroids (AS) on neonatal respiratory compliance. This model demonstrates the anticipated improvement in lung compliance for infants delivered within the 7 to 14-day windows following maternal administration of the initial course and rescue course of AS, as well as the time-limited nature of these increases.
See this image and copyright information in PMC

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