Use of prenatal glucocorticoid therapy to prevent respiratory distress syndrome. A supporting view.

In spite of recent major advances in the care of infants with neonatal respiratory distress syndrome (RDS), this disease continues to extract a great economic and emotional cost. Infants with RDS require sophisticated care for long periods of time, experience substantial morbidity, and may have long term sequelae from the disease or its therapy. However, it now appears that the incidence of RDS can be appreciably lowered by the use of prenatal glucocorticoid therapy in appropriate circumstances. In this commentary, we will review the history, effectiveness, safety, and probable mechanism of glucocorticoids in the acceleration of fetal lung maturation. Glucocorticoid Effects in Animals In 1969, Liggins 1 noted that a lamb born prematurely at 123 days (term is 150 days) after infusion of glucocorticoids was unexpectedly viable; it was postulated that corticosteroid treatment was inducing lung maturation and causing the appearance of surface active material (SAM) in alveolar spaces. Subsequent