Tratamiento con corticoides prenatales y surfactante precoz en recién nacidos de igual o menos de 30 semanas de gestación

Abstract

Background Prenatal corticosteroid (PNC) exposure and postnatal surfactant therapy improve outcome in very low birth weight infants (VLBWI). However, the efficacy of PNC in the prevention of chronic lung disease is debated Objective To study the effects of PNC exposure on outcome in VLBWI born at ≤ 30 weeks' gestation Patients and methods We performed a multicenter, longitudinal study. The Spanish Surfactant Group database (n = 1,275) was searched and 211 VLBWI born at ≤ 30 weeks who received early surfactant therapy (≤ 30 min) were identified. Perinatal events, neonatal management and rates of mortality and complications were evaluated. Data on the subgroup of infants who received PNC (157, 74.4%) were compared with data on 54 infants who did not receive this therapy Results Mean (± SD) birth weight and gestational age were 944 (226) g and 27 (1.8) weeks. Surfactant was given at 16 ± 13 min (61% ≤ 15 min). A total of 124 infants (58.8 %) developed respiratory distress syndrome. No differences were found in birth weight, gestational age, or Apgar score at 1 and 5 min. However the age at first surfactant dose was lower in infants exposed to PNC. PNC-exposed infants required fewer doses of surfactant, were extubated earlier (58.9 vs. 161 h) and needed a lower FiO2 at 48 h (0.28 vs. 0.35). Moreover, neonatal mortality (15.9 vs. 27.8 %), the incidence of intraventricular hemorrhage (25.2 vs. 50 %), ductus arteriosus (40.3 vs. 63.5 %) and necrotizing enterocolitis (9 vs. 19.2 %) were lower in infants receiving PNC. However, the incidence of chronic lung disease was similar in both groups Conclusions PNC exposure of VLBWI born at ≤ 30 weeks receiving early surfactant therapy reduced mortality and the incidence of certain complications but did not decrease the incidence of chronic lung disease