[Perinatal glucocorticosteroid therapy: time for reconsideration]

Area of Science:

• Neonatal care
• Pharmacology
• Developmental neuroscience

Background:

• Glucocorticosteroids are used to reduce pulmonary morbidity in preterm neonates.
• Antenatal corticosteroids improve survival and reduce respiratory distress syndrome and intraventricular hemorrhage.
• Concerns exist regarding potential adverse neurodevelopmental effects of multiple antenatal courses.

Purpose of the Study:

• To review the benefits and risks of antenatal and postnatal glucocorticosteroid administration in preterm neonates.
• To evaluate the long-term neurodevelopmental consequences of corticosteroid exposure.
• To provide guidance on the appropriate use of postnatal steroids for bronchopulmonary dysplasia.

Main Methods:

• Literature review of studies on antenatal and postnatal glucocorticosteroid use in preterm infants.
• Analysis of data on mortality, pulmonary morbidity, and neurodevelopmental outcomes.
• Comparison of different corticosteroid agents, such as betamethasone and dexamethasone.

Main Results:

• One course of antenatal corticosteroids is associated with decreased mortality and improved respiratory outcomes.
• Multiple courses of antenatal corticosteroids may be linked to impaired brain development.
• Postnatal dexamethasone treatment for bronchopulmonary dysplasia is associated with an increased rate of cerebral palsy.

Conclusions:

• Antenatal corticosteroids are beneficial for preterm neonates, but long-term neurodevelopmental follow-up is crucial.
• The use of betamethasone may offer advantages over dexamethasone.
• Postnatal steroid use for bronchopulmonary dysplasia should be reserved for severe, life-threatening cases due to risks of cerebral palsy.