PubMed · 6064946
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D G Freshwater. 1967. Fluocortolone.. https://doi.org/10.1111/j.1365-2133.1967.tb11455.x
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A patient had inadvertently mistaken her son's diflorasone diacetate ointment for gentamicin sulfate ophthalmic ointment and applied it to her eye in error. Although no serious consequences resulted from the instillation of the topical corticosteroid, this incident provides another example of mistaken medication tubes.
Respiratory distress syndrome (RDS) is the major cause of morbidity and mortality in preterm twin deliveries. Therapy with corticosteroids has been shown to reduce the incidence of RDS in preterm singleton gestations but similar reductions in twin pregnancies have not been demonstrated. Maternal and neonatal medical records were reviewed from twins delivered between 24 to 34 weeks gestation over the period of January 1, 1990 to December 31, 1994. Twenty-one pairs of twins received optimal steroid treatment defined as the use of two 12 mg doses of betamethasone, with birth occurring between 24 hours and 7 days after the first dose. Sixty-three pairs received no treatment. The mean gestational age at delivery was 29.9 +/- 2.6 weeks. No decrease was seen in the incidence of RDS (optimal steroid 70.7% versus no treatment 68.0%, unadjusted odds ratio [OR] 1.14, 95% confidence interval [CI] 0.49 to 2.65). Multivariate logistic regression showed no statistical difference in the incidence of RDS in the optimal steroid compared to the no treatment group (adjusted OR 0.63, 95% CI 0.2 to 1.95). No statistical differences were noted in the incidence of mechanical ventilation (58.6% versus 55.4%, p = 0.83), median duration of intubation (5.0 versus 5.0 days, p = 0.47), the median maximum inspiratory pressure requirements (20.0 versus 22.0 mm Hg; p = 0.15) in the optimal treatment versus no treatment group, respectively. The current regimen of antenatal corticosteroids utilized in twin pregnancies does not reduce the incidence of RDS.
OBJECTIVE: To develop a consensus on the use of antenatal corticosteroids for fetal maturation in preterm infants. PARTICIPANTS: A nonfederal, nonadvocate, 16-member consensus panel including representatives from neonatology, obstetrics, family medicine, behavioral medicine, psychology, biostatistics, and the public; 19 experts in neonatology, obstetrics, and pharmacology presented data to the consensus panel and a conference audience of approximately 500. EVIDENCE: An extensive bibliography of references was produced for the consensus panel and the conference audience using a variety of on-line databases including MEDLINE. The consensus panel met several times prior to the conference to review the literature. It also commissioned an updated meta-analysis, a neonatal registry review, and an economic analysis that were presented at the conference. The experts prepared abstracts for distribution at the conference, presented data, and answered questions from the panel and audience. The panel evaluated the strength of the scientific evidence using the grading system developed by the Canadian Task Force on the Periodic Health Examination and adapted by the US Preventive Services Task Force. CONSENSUS: The consensus panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. CONSENSUS STATEMENT: The consensus panel composed a draft statement that was read in its entirety at the conference for comment. The panel released a revised statement at the end of the conference and finalized the revisions a few weeks after the conference. CONCLUSIONS: Antenatal corticosteroid therapy is indicated for women at risk of premature delivery with few exceptions and will result in a substantial decrease in neonatal morbidity and mortality, as well as substantial savings in health care costs. The use of antenatal corticosteroids for fetal maturation is a rare example of a technology that yields substantial cost savings in addition to improving health.