Antenatal betamethasone and favourable outcomes in fetuses with 'poor prognosis' diaphragmatic hernia.
Congenital diaphragmatic hernia (CDH) is a common abnormality affecting 1 in 2,000 gestations. The mortality exceeds 50% despite recent advances in postnatal treatment. The widespread antenatal use of glucocorticoids to induce lung maturation in fetuses at risk of premature delivery suggests a potential for a therapeutic effect in other fetuses with impaired lung development. The parents of three fetuses referred with CDH and features suggesting a poor postnatal prognosis (early diagnosis, liver herniation, and lung area-to-head circumference ratio <1.0, or associated abnormalities) elected to receive maternal betamethasone starting at 24 to 26 weeks' gestation rather than undergo a fetal tracheal plug. All three infants survived and were extubated within 10 days. The long-term use of antenatal steroids in the treatment of CDH may thus be of benefit and warrants further study.
Ford
W D A
WD
Department of Paediatric Surgery, Women's and Children's Hospital, 72 King William Road, North Adelaide SA 5006, Australia.
Kirby
C P
CP
Wilkinson
C S
CS
Furness
M E
ME
Slater
A J
AJ
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001623:Betamethasone / Q000627:therapeutic use*; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy*; D006548:Hernia, Diaphragmatic / Q000188:drug therapy*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000187:drug effects* / Q000473:pathology*; D008297:Male; D011247:Pregnancy; D011379:Prognosis; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D001623:Betamethasone