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Perinatal corticosteroids and the developing lung
1North Trent Neonatal Intensive Care Unit, Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Tree Root Walk, Sheffield S10 2SF, UK. A.T.Gibson@Sheffield.ac.uk
Insights
Antenatal corticosteroids reduce infant mortality and respiratory distress. However, postnatal corticosteroid use for chronic lung disease in premature infants has questionable benefits and significant long-term risks.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Premature infants often develop respiratory disease and chronic lung disease, leading to high mortality and morbidity.
- Antenatal corticosteroid administration to mothers significantly reduces infant mortality, respiratory distress syndrome, and intracranial hemorrhage.
- Postnatal corticosteroids have been a long-standing treatment for chronic lung disease in premature infants.
Purpose of the Study:
- To evaluate the current understanding of corticosteroid use in premature infants.
- To critically assess the benefits versus the risks of postnatal corticosteroid therapy.
- To examine recent evidence questioning the established cost-benefit ratio of this treatment.
Main Methods:
- Review of recent meta-analyses on postnatal corticosteroid efficacy.
- Analysis of data on the side-effects of corticosteroid treatment.
- Evaluation of long-term adverse effects reported in recent studies.
Main Results:
- Recent meta-analyses indicate limited benefits of postnatal corticosteroids for chronic lung disease.
- Corticosteroid treatment is associated with various side-effects.
- Emerging evidence highlights significant and permanent long-term adverse effects.
Conclusions:
- The traditional assumption that the benefits of postnatal corticosteroids outweigh the risks is now questionable.
- Further research is needed to re-evaluate the risk-benefit profile of long-term corticosteroid use in premature infants.
- Clinical practice regarding postnatal corticosteroids requires re-evaluation in light of new evidence.
Abstract:
A significant number of infants are born prematurely each year, many of whom will develop respiratory disease and require ventilation. A substantial number of these infants will die and many of the survivors will subsequently develop chronic inflammatory lung disease. Administration of corticosteroids to women prior to a premature delivery is associated with a significant reduction in mortality and in the incidence of respiratory distress syndrome and intracranial haemorrhage in their infants once born. Postnatal administration of corticosteroids to the infant who develops chronic lung disease has been widely practised for many years. Recent meta-analyses have suggested that benefit may be limited. Treatment is also associated with a range of different side-effects but it has been assumed that the cost-benefit ratio favoured treatment. Recent evidence of permanent and highly significant long-term adverse effects has questioned the validity of this judgement.