Antenatal Corticosteroid Use And Clinical Evolution Of Preterm Newborn Infants [uso Antenatal De Corticosteóide E Evolução Clínica De Recém-nascidos Pré-termo]

Objectives: To describe the use of antenatal corticosteroid and clinical evolution of preterm babies. Methods: An observational prospective cohort study was carried out. All 463 pregnant women and their 514 newborn babies with gestational age ranging from 23 to 34 weeks, born at the Brazilian Neonatal Research Network units, were evaluated from August 1 to December 31, 2001. The data were obtained through maternal interview, analysis of medical records, and follow-up of the newborn infants. Data analysis was performed with the use of chi-square, t Student, Mann-Whitney, and ANOVA tests and multiple logistic regression, with level of significance set at 5%. Results: Treatment was directly associated with the number of prenatal visits, with maternal hypertension and with the antenatal use of tocolytic agents. Babies from treated pregnant women presented better Apgar scores at the 1st and 5th minute, reduced need for intervention in the delivery room and lower SNAPPE II. They were born with higher birth weight, longer gestational age and needed less surfactant use, ventilation, and oxygenation time. After multiple logistic regression, the use of antenatal corticosteroid independently improved birth conditions, decreased ventilation time, being related to increased occurrence of neonatal sepsis. Conclusions: The use of corticosteroid was associated with better prenatal care and birth conditions, better preterm evolution but higher risk of infection. © 2007 Sociedad Chilena de Pediatría.775531532Liggins, G.C., Howie, R.N., A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants (1972) Pediatrics, 50, pp. 515-525Crowley, P., Prophylactic corticosteroids for preterm birth (2002) Cochrane Database Syst Rev, (3). , CD000065Ryan, C.A., Finer, N.N., Antenatal corticosteroid therapy to prevent respiratory distress syndrome (1995) J Pediatr, 126, pp. 317-319Chien, L., Ohlsson, A., Seshia, M.M.K., Boulton, J., Sankaran, K., Lee, S.K., Variations in antenatal corticosteroid therapy: A persistent problem despite 30 years of evidence (2002) Obstet Gynecol, 99, pp. 401-408Albuquerque, I.C.C., Amorim, M.M.R., Meneses, J., Katz, L., Santos, L.C., Avaliação do impacto da corticiterapia antenatal para a aceleração da maturidade pulmonar fetal nos recém-nascidos em maternidade escola brasileira (2002) RBGO, 24, pp. 655-661Krauss-Silva, L., Costa, T.P., Reis, A.F., Iamada, N.O., Azevedo, A.P., Albuquerque, C.P., Avaliação da qualidade da assistência hospitalar obstétrica: Uso de corticóides no trabalho de parto prematuro (1999) Cad Saúde Pública, 15, pp. 817-829Chung, C.S., Myrianthopoulos, N.C., Congenital anomalies: Mortality and morbidity, burden and classification (1987) Am J Med Genet, 27, pp. 505-523Ballard, J.L., Khoury, J.C., Wedig, K., Wang, L., Eilers-Walsman, B.L., Lipp, R., New Ballard Score, expanded to include extremely premature infants (1991) J Pediatr, 119, pp. 417-423Alexander, G.R., Himes, J.H., Kaufman, R.B., Mor, J., Kogan, M., A United States National Reference for fetal growth (1996) Obstet Gynecol, 87, pp. 163-168Niermeyer, S., Kattwinkel, J., Van Reempts, P., Nadkarni, V., Phillips, B., Zideman, D., International Guidelines for Neonatal Resuscitation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines (2000) Pediatrics, 106 (3), pp. E29Apgar, V., A proposal for a new method of evaluation of the newborn infant (1953) Curr Res Anesth Analg, 32, pp. 260-267Richardson, D.K., Corcoran, J.D., Escobar, G.J., Lee, S.K., SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores (2001) J Pediatr, 138, pp. 92-100Walsh, M.C., Kliegman, R.M., Necrotizing enterocolitis: Treatment based on staging criteria (1986) Pediatr Clin North Am, 33, pp. 179-201Papile, L.A., Burstein, J., Burstein, R., Koffler, H., Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1,500 gm (1978) J Pediatr, 92, pp. 529-534Bloom, S.L., Leveno, K.J., Corticosteroid use in special circumstances: Preterm ruptured membranes, hypertension, fetal growth restriction, multiple fetuses (2003) Clin Obstet Gynecol, 45, pp. 150-160Gardner, M.O., Goldenberg, R.L., Gaudier, F.L., Dubard, M.B., Nelson, K.G., Hauth, J.C., Predicting low Apgar scores of infants weighing less than 1000 grams: The effect of corticosteroids (1995) Obstet Gynecol, 85, pp. 170-174Banks, B.A., Macones, G., Cnaan, A., Merrill, J.D., Ballard, J.D., Ballard, R.A., Multiple courses of antenatal corticosteroids are associated with early severe lung disease in preterm neonates (2002) J Perinatol, 22, pp. 101-107Vermillion, S.T., Soper, D.E., Chasedunn-Roak, J., Neonatal sepsis after betamethasone administration to patients with preterm premature rupture of membranes (1999) Am J Obstet Gynecol, 181, pp. 320-327Gunkel, J.H., Mitchell, B.R., Observational evidence for the efficacy of antenatal steroids from randomized studies of surfactant replacement (1995) Am J Obstet Gynecol, 173, pp. 281-285Antenatal corticosteroid therapy for fetal maturation (2002) Obstet Gynecol, 99, pp. 871-873. , ACOG Committee Opinio

Antenatal Corticosteroid Use And Clinical Evolution Of Preterm Newborn Infants

Objectives: To describe the use of antenatal corticosteroid and clinical evolution of preterm babies. Methods: An observational prospective cohort study was carried out. All 463 pregnant women and their 514 newborn babies with gestational age ranging from 23 to 34 weeks, born at the Brazilian Neonatal Research Network units, were evaluated from August 1 to December 31, 2001. The data were obtained through maternal interview, analysis of medical records, and follow-up of the newborn infants. Data analysis was performed with the use of chi-square, t Student, Mann-Whitney, and ANOVA tests and multiple logistic regression, with level of significance set at 5%. Results: Treatment was directly associated with the number of prenatal visits, with maternal hypertension and with the antenatal use of tocolytic agents. Babies from treated pregnant women presented better Apgar scores at the 1st and 5th minute, reduced need for intervention in the delivery room and lower SNAPPE II. They were born with higher birth weight, longer gestational age and needed less surfactant use, ventilation, and oxygenation time. After multiple logistic regression, the use of antenatal corticosteroid independently improved birth conditions, decreased ventilation time, being related to increased occurrence of neonatal sepsis. Conclusions: The use of corticosteroid was associated with better prenatal care and birth conditions, better preterm evolution but higher risk of infection. Copyright © 2004 by Sociedade Brasileira de Pediatria.804277284Liggins, G.C., Howie, R.N., A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants (1972) Pediatrics, 50, pp. 515-525Crowley, P., Prophylactic corticosteroids for preterm birth (2002) Cochrane Database Syst Rev, (3), pp. CD000065Ryan, C.A., Finer, N.N., Antenatal corticosteroid therapy to prevent respiratory distress syndrome (1995) J Pediatr, 126, pp. 317-319Chien, L., Ohlsson, A., Seshia, M.M.K., Boulton, J., Sankaran, K., Lee, S.K., Variations in antenatal corticosteroid therapy: A persistent problem despite 30 years of evidence (2002) Obstet Gynecol, 99, pp. 401-408Albuquerque, I.C.C., Amorim, M.M.R., Meneses, J., Katz, L., Santos, L.C., Avaliação do impacto da corticiterapia antenatal para a aceleração da maturidade pulmonar fetal nos recém-nascidos em maternidade escola brasileira (2002) RBGO, 24, pp. 655-661Krauss-Silva, L., Costa, T.P., Reis, A.F., Iamada, N.O., Azevedo, A.P., Albuquerque, C.P., Avaliação da qualidade da assistência hospitalar obstétrica: Uso de corticóides no trabalho de parto prematuro (1999) Cad Saúde Pública, 15, pp. 817-829Chung, C.S., Myrianthopoulos, N.C., Congenital anomalies: Mortality and morbidity, burden and classification (1987) Am J Med Genet, 27, pp. 505-523Ballard, J.L., Khoury, J.C., Wedig, K., Wang, L., Eilers-Walsman, B.L., Lipp, R., New Ballard Score, expanded to include extremely premature infants (1991) J Pediatr, 119, pp. 417-423Alexander, G.R., Himes, J.H., Kaufman, R.B., Mor, J., Kogan, M., A United States National Reference for fetal growth (1996) Obstet Gynecol, 87, pp. 163-168Niermeyer, S., Kattwinkel, J., Van Reempts, P., Nadkarni, V., Phillips, B., Zideman, D., International Guidelines for Neonatal Resuscitation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines (2000) Pediatrics, 106 (3), pp. E29Apgar, V., A proposal for a new method of evaluation of the newborn infant (1953) Curr Res Anesth Analg, 32, pp. 260-267Richardson, D.K., Corcoran, J.D., Escobar, G.J., Lee, S.K., SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores (2001) J Pediatr, 138, pp. 92-100Walsh, M.C., Kliegman, R.M., Necrotizing enterocolitis: Treatment based on staging criteria (1986) Pediatr Clin North Am, 33, pp. 179-201Papile, L.A., Burstein, J., Burstein, R., Koffler, H., Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1,500 gm (1978) J Pediatr, 92, pp. 529-534Bloom, S.L., Leveno, K.J., Corticosteroid use in special circumstances: Preterm ruptured membranes, hypertension, fetal growth restriction, multiple fetuses (2003) Clin Obstet Gynecol, 45, pp. 150-160Gardner, M.O., Goldenberg, R.L., Gaudier, F.L., Dubard, M.B., Nelson, K.G., Hauth, J.C., Predicting low Apgar scores of infants weighing less than 1000 grams: The effect of corticosteroids (1995) Obstet Gynecol, 85, pp. 170-174Banks, B.A., Macones, G., Cnaan, A., Merrill, J.D., Ballard, J.D., Ballard, R.A., Multiple courses of antenatal corticosteroids are associated with early severe lung disease in preterm neonates (2002) J Perinatol, 22, pp. 101-107Vermillion, S.T., Soper, D.E., Chasedunn-Roak, J., Neonatal sepsis after betamethasone administration to patients with preterm premature rupture of membranes (1999) Am J Obstet Gynecol, 181, pp. 320-327Gunkel, J.H., Mitchell, B.R., Observational evidence for the efficacy of antenatal steroids from randomized studies of surfactant replacement (1995) Am J Obstet Gynecol, 173, pp. 281-285Antenatal corticosteroid therapy for fetal maturation (2002) Obstet Gynecol, 99, pp. 871-873. , ACOG Committee Opinio

Klinefelter syndrome: cardiovascular abnormalities and metabolic disorders

Klinefelter syndrome (KS) is one of the most common genetic causes of male infertility. This condition is associated with much comorbidity and with a lower life expectancy. The aim of this review is to explore more in depth cardiovascular and metabolic disorders associated to KS. KS patients have an increased risk of cerebrovascular disease (standardized mortality ratio, SMR, 2.2; 95% confidence interval, CI, 1.6–3.0), but it is not clear whether the cause of the death is of thrombotic or hemorrhagic nature. Cardiovascular congenital anomalies (SMR, 7.3; 95% CI, 2.4–17.1) and the development of thrombosis or leg ulcers (SMR, 7.9; 95% CI, 2.9–17.2) are also more frequent in these subjects. Moreover, cardiovascular abnormalities may be at least partially reversed by testosterone replacement therapy (TRT). KS patients have also an increased probability of endocrine and/or metabolic disease, especially obesity, metabolic syndrome and type 2 diabetes mellitus. The effects of TRT on these abnormalities are not entirely clear