1. Problems of preterm infants

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

2. Role of ANS in preterm

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

3. Current recommendation

► 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

► Administration of ANS is integral in preterm labour

► Oral preparations of steroids are not to be used

► Repeated courses/ more frequent doses are not useful

► Multiple courses in fact could have harmful neuro-
    developmental effects in the baby

► ANCs have a role even if surfactant replacement is  available

5. Preparation

6. Route and dose

7. Indications for ANS

► True preterm labor

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

8. Contraindications for ANS

► Frank chorioamnionitis is an absolute contraindication for
    using antenatal corticosteroids

► 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?

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

11. Summary

► Antenatal steroids induce lung maturity in preterm fetus

► A single course of ANS can reduce neonatal morbidities
    including mortality to a significant extent

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