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Postnatal corticosteroids in preterm infants: systematic review of effects on mortality and motor function
1The Division of Newborn Services, the Royal Women's Hospital, Melbourne, Victoria, Australia.
Insights
Postnatal corticosteroids aid short-term breathing in preterm infants but do not improve survival rates. This therapy may increase the risk of motor dysfunction in survivors, necessitating further research.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Postnatal corticosteroid therapy is used to reduce ventilator dependence and chronic lung disease in preterm infants.
- While short-term side effects are minimal, long-term consequences like mortality and cerebral palsy require investigation.
Purpose of the Study:
- To review evidence from randomized controlled trials on the long-term effects of postnatal corticosteroids.
- Specifically examining impacts on mortality and motor dysfunction, including cerebral palsy.
Main Methods:
- A meta-analysis of reported randomized controlled trials was conducted.
- Event rate differences and 95% confidence intervals were calculated following Cochrane Collaboration guidelines.
Main Results:
- Mortality rate difference was statistically and clinically non-significant.
- Motor dysfunction was significantly higher in survivors exposed to postnatal corticosteroids.
- Survival free of motor dysfunction was significantly lower in the corticosteroid group.
Conclusions:
- Postnatal corticosteroids offer short-term benefits but do not enhance survival rates.
- This therapy may lead to increased motor dysfunction in surviving infants.
- A large-scale, placebo-controlled trial is needed to assess survival free of sensorineural impairments.
Background:
Postnatal corticosteroid therapy has been proved in randomized controlled trials to reduce ventilator dependence and the rate of chronic lung disease in preterm infants with few serious short-term side effects. However, there are other consequences that might follow postnatal corticosteroid therapy that are more important, including mortality or cerebral palsy.
Objectives:
To review the evidence from reported randomized controlled trials on the effects of postnatal corticosteroid on long-term mortality and motor dysfunction, including cerebral palsy.
Methods:
The methods involved a meta-analysis of reported randomized controlled trials, following guidelines of the Cochrane Collaboration, including calculation of event rate differences (ERD) and 95% confidence intervals (CI).
Results:
The mortality rate difference was non-significant both statistically and clinically (ERD - 0.1% favouring corticosteroids, 95% CI -2.9% to 2.8%). There were no subgroups in which a beneficial effect of postnatal corticosteroids on survival could be demonstrated. The rate of motor dysfunction in survivors was significantly higher in survivors from the postnatal corticosteroid group (ERD 11.9% favouring controls, 95% CI 4.6% to 19.2%). The rate of survival, free of motor dysfunction, was significantly lower in the postnatal corticosteroid group (ERD 7.8% favouring controls, 95% CI 0.5% to 15.1%).
Conclusions:
Although postnatal corticosteroids have short-term benefits, they do not increase the survival rate, and they may cause motor dysfunction in survivors. A large-scale, placebo-controlled randomized trial, with survival free of sensorineural impairments and disabilities as the major endpoint, is urgently needed.