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[Perinatal corticosteroid therapy: modalities, efficacy, consequences].

J F Magny1, V Rigourd, F Kieffer

  • 1Institut de Puériculture de Paris, 26, boulevard Brune, 75014 Paris.

Journal De Gynecologie, Obstetrique Et Biologie De La Reproduction
|March 10, 2001
PubMed
Summary
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Corticosteroids antenatally improve fetal maturity and reduce infant mortality. Postnatal use for bronchopulmonary dysplasia offers short-term benefits but raises long-term developmental concerns.

Area of Science:

  • Neonatal medicine
  • Pediatric pulmonology
  • Pharmacology

Context:

  • Corticosteroid therapy is utilized in neonatology for two primary indications: antenatal administration to enhance fetal lung maturity and postnatal treatment of bronchopulmonary dysplasia.
  • Antenatal corticosteroids significantly reduce the incidence of hyaline membrane disease and perinatal mortality, with additional benefits observed in intraventricular hemorrhage, hemodynamic failure, patent ductus arteriosus, and necrotizing enterocolitis.
  • While generally safe with few mild side effects after single courses, contraindications are rare.

Purpose:

  • To review the established benefits and emerging concerns of corticosteroid use during the perinatal period.
  • To evaluate the efficacy and safety profile of antenatal and postnatal corticosteroid treatments in neonates.
  • To highlight the need for further research into long-term outcomes of postnatal corticosteroid therapy for bronchopulmonary dysplasia.

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Summary:

  • Antenatal corticosteroid administration is a well-established intervention proven to enhance fetal lung maturity, decrease hyaline membrane disease, and reduce perinatal mortality and morbidity.
  • Postnatal corticosteroid therapy for bronchopulmonary dysplasia can shorten the duration of mechanical ventilation and oxygen dependence in premature infants.
  • However, postnatal corticosteroid use is associated with frequent acute side effects, and its impact on long-term mortality and neurodevelopmental outcomes remains uncertain, necessitating cautious application.

Impact:

  • Antenatal corticosteroid treatment represents a cornerstone of modern perinatal care, significantly improving neonatal outcomes.
  • Postnatal corticosteroid use for bronchopulmonary dysplasia requires careful risk-benefit assessment due to potential long-term adverse effects on growth and development.
  • Further research is crucial to optimize the therapeutic pathway for postnatal corticosteroid treatment, focusing on minimizing harm and maximizing benefits in vulnerable infants.