US recommendations for antenatal corticosteroids

public health

US recommendations for antenatal corticosteroids

Kazakhstan

adrenal suppression, and rapid return of adrenal function when antenatal corticosteroids are discontinued." : "Studies initiated in the 1970s, which followed the development of children treated antenatally with corticosteroids the maturation of fetal organ systems and to the age of 12 years, showed no adverse tissues, can significantly reduce morbidity outcomes in the areas of motor skills, lanand mortality from respiratory distress guage, cognition, memory, concentration syndrome (RDS), intraventricular haem- or scholastic achievement", the panel said. Antenatal administration of corticosorrhage, and other complications. All women between the 24th and 34th teroids can cause complications for the week of pregnancy who are exhibiting mother: these is some risk of pulmonary signs of a threatened premature delivery oedema in women being treated with should be considered candidates for antetocolytic agents; diabetic control may be natal treatment with betamethasone or more difficult; and there may be an dexamethasone, the panel said. : increased risk of maternal infection in The panel estimated that only about cases of preterm premature rupture of 15% of women delivering preterm infants membranes. However, the panel said, no in the USA are receiving antenatal cortilong term maternal adverse effects have been reported. are in because clinicians : costeroids, part The panel recommended treatment with concerned about the efficacy of the treatment and possible complications. The either 2 doses of betamethasone 12 mg panel said that a meta-analysis of 15 ran- given intramuscularly 24 hours apart or 4 domised controlled trials showed that doses dexamethasone 6 mg given intraantenatal corticosteroid administration led muscularly 12 hours apart. Optimum bento a reduction in the incidence of RDS efit begins 24 h after initiation of with a typical odds ratio of 0-5 (95% CI and lasts 7 days, but treatment begun 0-4-0-6) and a reduction of neonatal mor- less than 24 h before delivery can still protality with a typical odds ratio of 0-6 vide significant benefits. Furthermore, : corticosteroids should be given unless (0-5-0-8). : Randomised controlled studies also immediate delivery is anticipated. A full report will be published by the showed that antenatal corticosteroid treatment improved circulatory stability and National Institute of Child Health and reduced requirements for oxygen and venHuman Development this summer. : tilator support. : Concern about the effect on infant Michael McCarthy development seemed to be unwarranted, 1 National Institutes of Health. Consensus the panel said. "The evidence presented to development conference statement. Effect of date shows no increase in infection in corticosteroids for fetal maturation on treated infants, no clinically important perinatal outcomes. Feb 28-March 2, 1994.

The Baikonur space centre in Kazakhstan, and its associated town of Leninsk, have been the subject of a public-health enquiry. As a result of confusion and lack of funds, at the beginning of January, over 100 000 m3 of raw sewage leaked into the river Syr Darya, a feeder of the inland Aral Sea, which is already classified as an ecological disaster area of global

An NIH expert panel has strongly endorsed the use of antenatal corticosteroid injections to reduce the morbidity and mortality of premature birth. In its report’ the panel said that antenatal corticosteroid administration, which hastens

1

up

;

1

1

1

therapy

UK

"urgency" redefined

significance. Following this accident, Kazakhstan Deputy Premier Sergei Tereshohenko ordered an enquiry to examine the health hazards of the area. They reported that large areas of agricultural land had been damaged by highly toxic rocket fuel, from carrier rocket that fell to earth instead of burning up in the atmosphere, and that the subsoil around the space centre was also heavily contaminated by rocket fuel. This water was used by the centre without a

any treatment not

for

the

area

or

drinking

monitoring-although

purposes.

Furthermore,

around Baikonur had been used (presumably by the Soviet military) for dumping nuclear wastes. The head of Kazakhstan’s Department of the Environment is pressing that Russia, which claims to be the legal heir of the former USSR, should pay part of the clean-up costs, and that all future agreements with other CIS states on the use of Baikonur should have a built-in clause on environmental safety. But at present, the Kazakhstan ecologists are unable to enter the base without the permission of the base Commander-even if they form part of a government commission. Vera Rich is proposed that the fund could be in the course of 1994-1995.

News in brief

compromise has been reached on how deal with patients who are not emergencies but who require prompt investiga-

set up

A

Prize for STD test The Rockefeller . Chenobyl by choice Refugees from trouFoundation has launched a US$1 million ble-spots in the former USSR are settling tion or treatment. Last year, a new prize scheme for the development of ain the Chernobyl-contaminated areas of initiative to care for these "urgent" low-cost, rapid, and simple diagnostic test southern Belarus. More than 100 families patients within 6 weeks of referral wasfor chlamydia and gonorrhoea suitable for have applied for residence permits, saying announced (see Lancet 1993, Oct 23, use in poor countries. Details from the that they would rather "die slowly from radiation than quickly at the hands of p 1046). At the health secretary’s request Foundation at 1133 Avenue of the Americriminals". Local authorities are pleased each college prepared a list of signs and cas, New York, NY 10036. about the boost to their depleted workin their that would symptoms specialty indicate the need for an urgent referral. UK litigation fund UK health minister force. But, clinicians and public-health The lists produced proved too lengthy to ’., Brian Mawhinney has put forward workers are concerned about children be of practical use, and the scheme was proposals for the creation of a central moving to the area. fund for clinical negligence litigation. abandoned. In its place, the NHS mansoil and infant mortality agement executive, after consultation with One of the reasons for doing so is to Wet "enable NHS bodies to from Researchers the Flood Hazard ahead plan clinical representatives, circulated a letter with a greater degree of certainty ...". Research Centre, Middlesex University, to all managers. "Although it is not possiAt such costs the London, UK, have reported a correlation present, litigation ble to be prescriptive about the conditions . NHS in an estimated between the wetness of soil and infant England C75 be classified as which would urgent, the decision as to whether a patient needs million per year. The proposed fund mortality. They studied data from the 2540 infant deaths that occurred between treatment urgently or not will properly be would receive contributions from profor the doctors involved in the patient’s vider units, which would be used to 1987 and 1990 in six counties of southern England. On average, per 1000 births, 2 care." : meet a significant amount of members’ total financial liability in larger claims. to 3 more babies died in areas with wet Sarah Ramsay Membership should be voluntary. It soil than those with dry soil. to

1

1

1

1

1

1

726