Calcium-channel blockers have neonatal benefits
I enjoyed reading Professor Shennan's update article on Obstetrics.
Two meta-analyses of the use of calcium-channel blockers as tocolytics
have shown a benefit to the neonate which is independant of steroid
In a meta-analysis by James King and colleagues, administration of
calcium-channel blockers as acute tocolysis, showed a significant
reduction in RDS (RR, 0.63; 95% CI 0.46, 0.88), Necrotising enterocolitis
(RR, 0.21; 95% CI 0.05, 0.96), IVH (RR, 0.59; 95% CI 0.36, 0.98) and
admissions to a NICU (RR, 0.78; 95% CI 0.64, 0.95).
Most units in New Zealand have been using nifedipine as an acute
tocolytic for the last 12 months and we find it preferable to salbutamol
which we were previously using. As Professor Sheenan pointed out in his
article, nifedipine is not licensed for this use, although it has been
used for many years in pre-eclampsia. As a result, we have a very clear
protocol which we developed at National Women's Hospital which guides the
use of nifedipine as a tocolytic. We would be happy to share this with
colleagues overseas if they were keen to switch over to nifedipine.
King, Flenady, Papatsonis, Dekker and Carbonne. Aust NZ J O&G.
2003; 43: 192-198.
Competing interests: No competing interests