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Postnatal corticosteroids and sensorineural outcome at 5 years of age
1The Royal Women's Hospital, the Mercy Hospital for Women, Monash Medical Centre, the Royal Children's Hospital, the Newborn Emergency Transport Service, and the Victorian Perinatal Data Collection Unit, Melbourne, Australia.
Insights
Postnatal corticosteroid therapy in preterm infants is linked to increased risks of cerebral palsy, blindness, and lower IQ. These adverse sensorineural outcomes highlight potential long-term harms despite short-term benefits.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Pediatric Neurology
Background:
- Postnatal corticosteroids are used to reduce ventilator dependence in preterm infants.
- Long-term benefits for survival and sensorineural morbidity remain unproven.
Purpose of the Study:
- To investigate the association between postnatal corticosteroid therapy and sensorineural outcomes in childhood.
- To evaluate the long-term effects of these treatments on neurodevelopment.
Main Methods:
- A cohort study of 346 very preterm infants (birth weight < 1000g or gestational age < 28 weeks) born in Victoria, Australia.
- Infants were followed to 5 years of age, with 120 receiving postnatal corticosteroids.
Main Results:
- Children treated with postnatal corticosteroids showed significantly higher rates of cerebral palsy (23% vs 4%), blindness (4% vs 1%), and intellectual disability (IQ < 70; 54% vs 32%) at 5 years.
- The association persisted after adjusting for confounding variables.
- Cerebral palsy rates remained elevated in a case-control subgroup analysis.
Conclusions:
- Postnatal corticosteroid therapy in extremely preterm infants is associated with significant adverse sensorineural outcomes at 5 years of age.
- These findings suggest potential neurodevelopmental risks that warrant careful consideration.
Background:
Postnatal corticosteroids reduce ventilator dependence in preterm infants, but possible long-term benefits for either survival or sensorineural morbidity are not proved.
Aim:
The aim of this study was to determine the association between corticosteroid therapy given postnatally and sensorineural outcome in childhood.
Subjects:
The subjects comprised 346 consecutive livebirths either of birthweight < 1000 g or with gestational age < 28 weeks born in the state of Victoria during 1991 and 1992, and who survived the first week after birth; 120 (34.7%) were given corticosteroids postnatally.
Results:
Of the 120 children who received corticosteroids, 98 (81.7%) survived to 5 years of age, compared with 200 (88.5%) of the 226 children who did not receive corticosteroids. At 5 years of age, survivors treated with corticosteroids postnatally had significantly higher rates of cerebral palsy (corticosteroids 23%, no corticosteroids 4%), blindness (corticosteroids 4%, no corticosteroids 1%) or an intelligence quotient more than one standard deviation below the mean (corticosteroids 54%, no corticosteroids 32%) compared with children not treated with corticosteroids. The rate of sensorineural disabilities imposed by these impairments was significantly higher in children treated with postnatal corticosteroids, and the association between adverse sensorineural outcome and postnatal corticosteroids remained after adjustments for potentially confounding variables. In a separate case-control analysis of 60 children in each group, the rate of cerebral palsy remained significantly elevated (corticosteroids 22%, no corticosteroids 5%).
Conclusion:
Postnatal corticosteroid therapy is associated with substantial adverse sensorineural outcomes at 5 years of age.