Effect of single and multiple courses of maternal betamethasone on prenatal congenital lung lesion growth and fetal survival

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• 作者：William H. Peranteau ; ^{peranteauw@email.chop.edu" class="auth_mail" title="E-mail the corresponding author} ; Matthew M. Boelig ; Nahla Khalek ; Julie S. Moldenhauer ; Juan Martinez-Poyer ; Holly L. Hedrick ; Alan W. Flake ; Mark P. Johnson ; N. Scott Adzick
• 关键词：Betamethasone ; Hydrops ; CCAM ; Fetal surgery ; Congenital lung lesion ; Steroids
• 刊名：Journal of Pediatric Surgery
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：51
• 期：1
• 页码：28-32
• 全文大小：412 K

文摘

Administration of maternal betamethasone (BMZ) is a therapeutic option for fetuses with large microcystic congenital lung lesions at risk for, or causing, hydrops. Not all fetuses respond to a single course of BMZ. We review our experience with the use of single and multiple courses of maternal BMZ for the management of these patients.

Methods

A retrospective review of fetuses with congenital lung lesions managed with maternal BMZ from 2003 to 2014 was performed.

Results

Forty-three patients were managed with prenatal steroids (28 single course, 15 multiple courses). Single course recipients demonstrated a reduction in lesion size and resolution of hydrops in 82% and 88% of patients respectively compared to 47% and 56% in recipients of multiple steroid courses. Survival of multiple course patients (86%) was comparable to that of single course patients (93%) and improved compared to non-treated historical controls. Multiple course recipients demonstrated an increased need for open fetal surgery and postnatal surgery at a younger age.

Conclusion

Fetuses who fail to respond to a single course of BMZ may benefit, as indicated by hydrops resolution and improved survival, from additional courses. However, failure to respond is indicative of a lesion which may require fetal or immediate neonatal resection.