title: Effect of single and multiple courses of maternal betamethasone on prenatal congenital lung lesion growth and fetal survival.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States. Electronic address: peranteauw@email.chop.edu.
authors.forename: William H
authors.initials: WH
authors.lastname: Peranteau
authors.affiliation: The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Boelig
authors.affiliation: The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Nahla
authors.initials: N
authors.lastname: Khalek
authors.affiliation: The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Julie S
authors.initials: JS
authors.lastname: Moldenhauer
authors.affiliation: The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Juan
authors.initials: J
authors.lastname: Martinez-Poyer
authors.affiliation: The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Holly L
authors.initials: HL
authors.lastname: Hedrick
authors.affiliation: The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Flake
authors.affiliation: The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Johnson
authors.affiliation: The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001623:Betamethasone / Q000008:administration & dosage* / Q000627:therapeutic use; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D004334:Drug Administration Schedule; D005260:Female; D046128:Fetal Therapies / Q000379:methods*; D006801:Humans; D015160:Hydrops Fetalis / Q000209:etiology; D007231:Infant, Newborn; D011295:Prenatal Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D001623:Betamethasone
keywords: Betamethasone; CCAM; Congenital lung lesion; Fetal surgery; Hydrops; Steroids