1. Problems of preterm infants

â–º Respiratory Distress Syndrome (RDS)
â–º Increased susceptibility to infections
â–º Intraventricular hemorrhage
â–º Necrotizing enterocolitis
â–º Patent ductus arteriosus
â–º Broncho pulmonary dysplasia

2. Role of ANS in preterm

â–º 45% reduction in Respiratory Distress Syndrome (RDS)
â–º 46% reduction in Intra Ventricular Haemorrhage (IVH)
â–º 54% reduction in Necrotizing Enterocolitis (NEC)
â–º 31% reduction in mortality

3. Current recommendation

â–º Single course of Inj. Dexamethasone to be administered
    to women with preterm labor (between 24 - 34 weeks of
    gestation) at all levels of health facilities in the public as
    well as the private sector

4. Current recommendations

â–º Administration of ANS is integral in preterm labour

â–º Oral preparations of steroids are not to be used

â–º Repeated courses/ more frequent doses are not useful

â–º Multiple courses in fact could have harmful neuro-
    developmental effects in the baby

â–º ANCs have a role even if surfactant replacement is  available

5. Preparation

6. Route and dose

7. Indications for ANS

â–º True preterm labor

â–º Following conditions that lead to imminent delivery are
      ♦ Antepartum hemorrhage
      ♦ Preterm premature rupture of membrane
      ♦ Severe pre-eclampsia

8. Contraindications for ANS

â–º Frank chorioamnionitis is an absolute contraindication for
    using antenatal corticosteroids

â–º Following signs and symptoms in the mother suggests
    Frank amnionitis
      ♦ History of fever and lower abdominal pain
      ♦ On examination: Foul smelling vaginal discharge,
         tachycardia and uterine tenderness
      ♦ Fetal tachycardia

9. Maternal diabetes

Maternal diabetes, pre-eclampsia and hypertension are not contraindications for using injection corticosteroid
in pregnant women.

Dexamethasone can be administered if otherwise indicated with a careful watch on blood sugar and blood pressure

10. What to expect?

â–º ANS therapy - Maximal effect, if fetus is delivered 24 hours
    after the last dose and up to 7 days thereafter

11. Summary

â–º Antenatal steroids induce lung maturity in preterm fetus

â–º A single course of ANS can reduce neonatal morbidities
    including mortality to a significant extent

â–º Dexamethasone is the drug of choice for administration to
    women with preterm labor between 24-34 weeks of gestation