Are Weekly Courses of Antenatal Steroids Beneficial or Dangerous?

To the Editor: Dr Guinn and colleagues¹ found that multiple courses of antenatal corticosteroids did not produce significant change in the rate of respiratory distress syndrome (RDS) Hyaline membranes in the lungs of premature infants consist primarily of fibrin. During embryonic development there is minimal plasminogen produced except in the last weeks of pregnancy, and normal adult levels are reached only 7 months postpartum. Thus in premature infants the fibrinolysin system is inadequate to dissolve hyaline membranes.² For this reason we have treated a series of 500 premature infants with plasminogen or placebo postpartum, and demonstrated significant prevention of RDS.³ Those still developing RDS were given intravenous and aerosolized plasmin, resulting in significant reduction of mortality, without significant side effects. Four-year followup⁴ did not find important long range effects in contrast to the findings of Guinn et al. It appears that plasminogen (fibrinolytic), surfactant, and single-course corticosteroid therapy should be explored alone and in combination.