Antenatal corticosteroids preterm birth

Current use in High-Resource Settings
Corticosteroids are not currently labeled for use in preterm labor in the US; however, coricosteroids are commonly used for preterm delivery. Given the relatively low cost and ease of administration, increased penetration is limited by the ability to quickly diagnose an at-risk fetus. Cost savings associated with the avoidance of surfactant and respiratory support are substantial.

Application in Low-Resource Settings
Where surfactant and ventilation are less likely to be available, corticosteroid use has the potential to save lives. In facility settings and among skilled attendants, intramuscular injection is feasible. There are ongoing efforts to pre-load betamethasone into the Uniject device in order to further reduce the skill required for administration. This could expand the base of end users, but is not yet commercially available. Corticosteroid therapy is not advised for women who have systemic infections such as tuberculosis. Caregivers in regions with high prevalence of infectious disease must be more cautious before administration of this drug.

The germinal matrix is the site of proliferating neuronal and glial precursors in the developing brain, which is located above the caudate nucleus , in the floor of the lateral ventricle , and caudothalamic groove. The germinal matrix contains a rich network of fragile thin-walled blood vessels. Hence the microcirculation in this particular area is extremely sensitive to hypoxia and changes in perfusion pressure. It is most frequent before 35 weeks gestation and is typically seen in very low birth-weight (<1500g) premature infants , because they lack the ability for auto regulation of cerebral blood flow. Consequently, increased arterial blood pressure in these blood vessels leads to rupture and hemorrhage into germinal matrix. [2]

Toolkits, triggers, bundles, protocols, and checklists are examples of tools that can be used directly by the clinician to facilitate improvements in quality of care and to lead to improvements in outcomes. A bundle is usually defined as a set of evidence-based best practices, that when implemented, are designed to achieve optimal patient outcomes. This initiative is defined as a ‘toolkit,’ to adjust for the fact that while there was an effort to present only evidenced-based suggestions for care, the evidence for some of these suggestions is limited, or somewhat controversial. There is recognition that currently we do most of the right things for most of the patients most of the time, and our goal is to reliably do all of the right things, for all of the patients all of the time. This toolkit is not meant to mandate exclusive ways of managing certain conditions or clinical situations. This is an effort to help standardize care so that all members of the team can work better together, and can come closer to achieving this ideal. Within a toolkit are tools designed to assess barriers and to assist execution to improve care in a wide variety of clinical settings.  These materials are designed to strike a balance between standardization and clinical discretion.  

Antenatal corticosteroids preterm birth

antenatal corticosteroids preterm birth


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