P171 Antenatal corticosteroid therapy: to determine the level of adherence to protocol in preterm neonates. (June 2019)

• Record Type: Journal Article
• Authors: Kasha, Sarah; Hamid, Aliya; Fox, Brian; O'Neill, Michael B
• Is Part Of: Archives of disease in childhood. Volume 104:Supplement 3(2019)
• Page Start: A226
• Page End: A226
• Publication Date: 2019-06
• Subjects: Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2019-epa.526
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Background and aim: Institute of Obstetricians and Gynaecologists (RCPI) guideline for preterm prelabour rupture of the membranes (PPROM) recommends the administration of antenatal corticosteroids for women who are 24 to 36 weeks pregnant with anticipated preterm labour. It reduces the risks of respiratory distress syndrome, intraventricular haemorrhage and necrotizing enterocolitis. Recommended steroid is 12 mg of intramuscular Betamethasone given 24 hours apart and at least 24 hours before delivery. This study determined the level of adherence to the guidelines. Methodology: Mothers who presented in preterm prelabour rupture of membranes between 1/1/2015 and 31/12/2018 were incorporated into this study. Mothers were evaluated for maternal age, parity, body mass index, ethnicity and demographic distribution. Babies were evaluated for gender, gestational age, weight, corticosteroid type and time of administration prior to delivery, number of doses, type of respiratory support, comorbidities and length of hospital stay. Data was recorded on a collection sheet. Results: 103 mothers with PPROM were eligible to receive antenatal steroids, of whom 44(43%) received recommended treatment and 59(57%) received incomplete or no treatment. Out of infants who received complete course of antenatal steroids, 7(16%) required surfactant and intubation, 3 (7%) required CPAP and surfactant, 16(36.4%) required only CPAP, 1 (2%) required high flow oxygen and 17(38.6%) did not need any respiratory support. Of the 59 infants who had an incomplete course or no steroids, 12(20%) required surfactant and intubation, 4(6.8%) required surfactant and CPAP, 20(34%) required CPAP, 1 (2%) required low flow oxygen and 22(37.2%) did not require any support. Of those who received complete treatment, 26 were early preterm (28-<34 weeks) and 20 were late preterm (34–34+5 weeks). Of those who received incomplete or no treatment, 28 were early preterm and 29 were late preterm. The mean gestational age for infants who received complete treatment was 30 ± 2 weeks, and for those who received incomplete treatment was 32 ± 2 weeks. Of the 103 mothers, 88(85.4%) were Irish and 15(14.6%) were Non-Irish. Conclusion: It was found that adherence to guideline is satisfactory. Imminent preterm delivery prevented 100% adherence to the protocol. This is a risk reduction strategy and parents should be made aware of the possible outcomes.