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

PICO(T) is an acronym that is used to help nurses and other professionals to formulate a clinical question and guide the search for evidence. It stands for patient/population/problem, intervention, comparison, outcomes, and time frame. In this paper, the question being asked does administering betamethasone or dexamethasone in late preterm pregnancy improves neonatal outcomes in the preterm infant compared to infants who do not receive one of these drugs.

According to research, late preterm delivery is considered a delivery that happens between 34- and 37 weeks gestation. In these infants, there is a high risk for adverse lung-related issues. More and more women are delivering during this gestation in pregnancy. “Late preterm infants (born between 34 weeks and 36 weeks 5 days of gestation) make up the largest proportion of preterm births and are at a higher risk for neonatal deaths and complications including respiratory disease than are infants born at term (at least 37 weeks of gestation)” (Crowther & Harding, 2016). Therefore, the need for research on this topic is important in caring for mothers who have an increased risk for delivering late preterm.

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

By using a PICO(T) approach for this particular question, the question is clearly stated, making it easier to find articles with information that will assist in answering the question. For this type of question, the sources used for findings are multi-center, placebo-controlled, randomized trials and systemic review and meta-analysis. A multi-centered, placebo-controlled, randomized trial is a medical study that is done in more than one clinic or medical setting. It involves human participants in which neither side knows who is getting the actual medication being studied and who is getting the placebo. A systemic review attempts to gather all available empirical research by using clearly defined, systemic methods to obtain answers to a specific question, and meta-analysis is a statistical process of analyzing and combining results from several similar studies. By using a multi-centered placebo-controlled randomized trial, researchers are able to look at the effects of the neonates who received betamethasone in several different settings and compare them to the effects of the neonates who did not receive this same drug. By using the systemic review and meta-analysis to answer this question, the researcher looks at several studies on this topic and combines the results together to make a conclusion (Ahn & Kang, 2018)

In the article titled, Antenatal Betamethasone for Women at Risk for Late Preterm Delivery (2016), written in the New England Journal of Medicine, the authors conducted a multi-center, randomized trial which involved women with a singleton pregnancy between the gestational ages of 34.0 weeks and 36.5 weeks who were considered high risk for preterm delivery. They found at the conclusion of this study that administering betamethasone to the women in this study significantly reduced the rate of neonatal outcomes. They found that 8% of all deliveries occur in the late preterm period and that because of this, the potential public health and economic effects of decreasing the rate of complications by administering betamethasone are considerable. (Gyamfi-Bannerman, et al, 2016, p. 1312). The results of the study showed that the rate of severe respiratory outcomes was significantly lower in the betamethasone group as well as the rate of resuscitation at birth and surfactant use which can lead to a decrease in a prolonged stay in a special care nursery.

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

Crowther, C.A., & Harding, J.E., (2016). Antenatal glucocorticoids for late preterm birth? The New England Journal of Medicine. 374(14). 1376-1377. Antenatal Glucocorticoids for Late Preterm Birth? | NEJM

Saccone, G., & Berghella, V., (2016). Antenatal corticosteroids for maturity of term or near term fetuses: a systemic review and meta-analysis of randomized control trials. BJM. 355(5044). Antenatal corticosteroids for maturity of term or near term fetuses: a systematic review and meta-analysis of randomized controlled trials | The BMJ

Ahn, E., & Kang, H., (2018). Introduction to systemic review and meta-analysis. Korean Journal of Anesthesiology. 71(2) 103-112. Introduction to a systematic review and Meta-analysis (nih.gov)

Dellwo, A., (2021), Double-blind, placebo-controlled, clinical trial basics, Verywell Health. Double-Blind, Placebo-Controlled Clinical Trial Basics (verywellhealth.com)

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Question

Create a 3-5-page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question.