Nurs-fpx 4030 assessment 3 – PICOT Questions and an Evidence-Based Approach

 
Another article that answers this PICO(T) question uses a systemic review with meta-analysis. It was written by Saccone and Berghella in 2016. They asked the question, does the use of antenatal steroids at 34 weeks or more gestation reduce neonatal respiratory morbidity? In this study, they used six trials of singleton pregnancies as well as data from a follow-up randomized control trial. This study “evaluated the efficacy of prophylactic antenatal corticosteroids (betamethasone or dexamethasone) given at or after 34 weeks” (p. 4). The result was that administering corticosteroids reduces neonatal morbidity. According to Saccone and Berghalla, “dexamethasone and betamethasone are the two antenatal corticosteroids recommended for accelerating fetal lung development in threatened preterm birth” (p. 6). They also found it their study that administering a single dose of corticosteroids should be considered for women undergoing a planned c-section at 37 weeks or more to reduce neonatal morbidities.

Both of these articles contain information that shows it is beneficial to administer corticosteroids to late preterm neonates. According to the studies, they both found that with administering corticosteroids to neonates, the neonates’ development of neonatal hypoglycemia is higher in the corticosteroid group than in the placebo group. Yet, the positive effects of fetal lung maturation and decreasing neonatal morbidity overshadow this side effect. Therefore, this information shows that the answer to the PICO(T) question is yes; administering betamethasone or dexamethasone in late preterm pregnancy does improve neonatal outcomes in the preterm infant compared to infants who do not receive one of these drugs.

References
Gyamfi-Bannerman, Thom, E.A., Blackwell, S.C., Tita, A., T., N., Reddy, U.M., Saade, G.R., Rouse, D.J., McKenna, D.S., Clark, E.A.S., Thorp, Jr., J.M., Chien, E.K., Peaceman, A.M., Gibbs, R.S., Swamy, G.K., Norton, M.E., Casey, B.M., Caritis, S.N., Tolosa, J.E., Sorokin, Y., VanDorsten, J.P., & Jain, L., (2016). Antenatal betamethasone for women at risk for late preterm delivery. The New England Journal of Medicine. 374(14), 1311-20. Antenatal Betamethasone for Women at Risk for Late Preterm Delivery | NEJM