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Effect of exogenous corticosteroids on the developing central nervous system: a review
W L Huang1, S A Dunlop, C G Harper
1Department of Zoology, University of Western Australia, Nedlands, Australia. wenlong@cyllene.uwa.edu.au
Insights
Maternal corticosteroid use during pregnancy and infancy has potential risks. Animal studies show developmental neurotoxicity, necessitating further research into the long-term safety of these treatments.
Area of Science:
- Neonatal care
- Developmental neuroscience
- Pharmacology
Background:
- Corticosteroid therapy is utilized in prenatal and postnatal settings, including preventing respiratory distress syndrome and treating infant diseases.
- Current treatment protocols involve frequent administration without robust safety data from randomized clinical trials.
Purpose of the Study:
- To evaluate the safety and efficacy of corticosteroid therapy in developmental clinical settings.
- To investigate the long-term effects of prenatal and neonatal corticosteroid exposure on the central nervous system (CNS).
Main Methods:
- Review of existing animal studies, primarily in rodents, examining prenatal and neonatal corticosteroid administration.
- Analysis of reported detrimental effects on CNS development and potential neuroprotective properties.
Main Results:
- Animal studies indicate that repeated prenatal or neonatal corticosteroid exposure can harm developing CNS structure and function.
- Some studies suggest corticosteroid pretreatment may protect the brain from hypoxia-ischemic injury, though clinical use is declining.
Conclusions:
- There is a significant lack of long-term safety data from randomized clinical trials regarding repeated corticosteroid administration.
- Further research using large animal models with long-term follow-up is crucial to determine the risks and benefits of exogenous corticosteroid use in development.
Abstract:
Corticosteroid therapy is used in a variety of developmental clinical settings. Prenatally, maternal administration of corticosteroids is used primarily in the prevention of respiratory distress syndrome. Postnatally, corticosteroids are used to treat a variety of infant diseases such as autoimmune hemolytic anemia and hypoglycemia. Treatment regimes often involve repeated administration, on a weekly basis prenatally and daily postnatally, despite an absence of safety data from randomized clinical trials. A large number of animal studies, the majority of which used rodents, have shown that both repeated prenatal or neonatal administration of exogenous corticosteroids has a wide range of detrimental effects on the structure and function of the developing central nervous system (CNS). None of these studies included long-term follow-up. Despite the reported detrimental effects on CNS development, a number of animal studies have shown that pretreatment with corticosteroids nevertheless protect the brain from hypoxia-ischemic injury; however, clinically such treatment is no longer favored. Studies using large animal models and with long-term follow-up should be undertaken to establish the relative risks and benefits of the repeated application of exogenous corticosteroids.
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