Prenatal TRH, in addition to corticosteroids, given to women at risk of very preterm birth do not improve infant outcomes and can cause maternal side-effects.
Combined hormonal therapy for the prevention of respiratory distress syndrome and its consequences.
In performing this meta-analysis, we have attempted to use comparable data, but there are limitations to the information that is available at present. Some studies reported results for all patients entered, whereas others reported only optimally treated patients (Table 2). Many of the trials have not yet been published in final form and subjected to peer review. In addition, all the studies reported here were conducted before the widespread use of surfactant therapy. It is unclear whether the benefit of antenatal TRH and steroid therapy on end points such as death or BPD would persist if surfactant was also used. (Surfactant has, however, little impact on the percentage of survivors with BPD, perhaps because sicker infants survive with this treatment and go on to develop BPD.) Studies comparing antenatal TRH plus steroid plus postnatal surfactant to antenatal steroid plus postnatal surfactant are clearly required, and are in progress in a number of centers around the world. Because of these limitations, the routine use of antenatal TRH plus steroid cannot be currently recommended. However, the apparent benefits of this therapy in terms of RDS, death, and CLD that have been reported here do suggest that it might be used in selected situations. An example is threatened delivery of a very premature infant with an immature amniotic fluid pulmonary maturation profile. These infants are at risk for RDS and CLD, even if antenatal steroid and postnatal surfactant therapy is used.(ABSTRACT TRUNCATED AT 250 WORDS)