Desfecho neonatal do uso pré-natal de corticosteróides: scoping review

Abstract

Premature birth has a worldwide incidence of 15 million every year. In this context, premature neonates are more likely to suffer from Respiratory Distress Syndrome (RDS), sepsis, intraventricular hemorrhage, necrotizing enterocolitis and neurological problems soon after birth. Thus, the administration of maternal corticosteroids for fetal lung maturation in those at risk of preterm labor has been reported as effective in preventing respiratory distress syndrome and consequently perinatal and neonatal death. Thus, the objective of this study was to map the neonatal outcome related to the use of corticosteroids by pregnant women at risk of preterm labor. This work is a scoping review, based on the recommendations of the Joanna Briggs Institute. The searches were conducted in the Medical Literature Analysis and Retrieval System Online (MEDLINE) databases, via PubMed, Virtual Health Library (VHL), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Cochrane Library and Embase, through the Journal Portal of the Coordination for the Improvement of Higher Education Personnel (CAPES). In turn, the search in gray literature was carried out through Google Scholar and the CAPES Theses and Dissertations Portal. The health sciences descriptors used were: Premature Newborn, Premature Labor and Corticosteroids combined with the Boolean operator AND. Studies in English, Portuguese and Spanish were considered, with no time frame. The data were extracted, tabulated and analyzed by two researchers independently. A total of 1,241 studies were retrieved from all the databases and portals analyzed, of which 13 comprised the final sample of this study. The included articles evaluated the positive and negative neonatal outcomes of the use of betamethasone and dexamethasone, alone or in combination. Maternal use of corticosteroids in women at risk of preterm labor (PTL) is effective in preventing RDS, reducing the rates of intraventricular hemorrhage, RDS, necrotizing enterocolitis, retinopathy of prematurity, and bronchopulmonary dysplasia. However, the negative neonatal outcomes identified were increased rates of patent ductus arteriosus, sepsis, neonatal hypoglycemia, head circumference below the cohort point, high blood pressure, and hyperthyrotropinemia. Regarding the drugs used (betamethasone alone, dexamethasone alone, or betamethasone and dexamethasone combined), dosage, and gestational age for administration of the first dose, there was no unanimous consensus.