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Preterm babies- improving outcome
Two modalities, prenatal steroids and postnatal surfactant administration are the one which can improve the
outcome in premature babies.
Administration of corticosteroids
Benefits: redction in incidence of respiratory distress syndrome( R.D.S.) and intraventicular haemorrhage by 50%. Overall reduction in foetal mortality in preterm babies is by 40%.
It improves the quality of endogenous surfactant produced by the foetus
Use of prenatal steroids further improves the effect of postnatal surfactant therapy
Optimum effect is seen if delivery occurs after 24 hrs. of the initiation of therapy and the effect lasts for 7 days.repeat administration is required if the delivery occurs after 7 days of the first dose.
Indication: all foetus between 24-34 weeks of gestation who are at risk of preterm delivery.
Side effects: repeated doses can inhibit nuclear protein synthesis and thus initiating cellular apoptosis as result growth of the foetus gets restricted, they have smaller head circumfrenceand reduced brain volume.
Points to remember : use single course. According to latest consensus single is better than multiple doses.
Prefer betamathasone over dexamethasone.
Surfactant replacement therapy :
Provide opportunity for surfactant therapy as early as possible before lung injury sets in.
Inform skilled paediatrician
Avoid condition which can damage pneumocytes || : like asphyxia,hypothermia,hypoxia,acidosis,poor perfusion,
Pneumocytes|| are responsible for the production of endogenous surfactant
Published: December 15, 2007
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