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Effects of phenobarbital and multiple-dose corticosteroids on developmental outcome at age 7 years
James A Thorp1, Mary O'Connor, Brian Belden
1Regional Perinatal Center, Sacred Heart Women's Hospital, Pensacola, Florida 32513, USA. jathorp@bellsouth.net
Insights
Antenatal phenobarbital and repeated antenatal corticosteroid use did not show adverse effects on children's intelligence, achievement, or behavior at age 7. This study found no significant differences in developmental outcomes for children exposed to these treatments in utero.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Pharmacology
Background:
- Antenatal phenobarbital and vitamin K were studied for preventing severe intracranial hemorrhage.
- Repetitive antenatal corticosteroid therapy was administered to mothers in the trial.
- Long-term effects of these antenatal treatments on child development require investigation.
Purpose of the Study:
- To assess the impact of antenatal phenobarbital and repeated antenatal corticosteroid use on children's intelligence and achievement at age 7.
- To evaluate secondary outcomes including behavior and head circumference at age 7.
Main Methods:
- Secondary analysis of a double-blind clinical trial comparing phenobarbital-vitamin K versus placebo.
- Intelligence, achievement, and behavioral testing performed at age 7.
- Head circumference measurements were also collected at age 7.
Main Results:
- No significant differences were observed in Wechsler Intelligence Scale for Children (WISC-III) scores (Full Scale, Performance, Verbal IQ) between groups.
- No significant differences were found in Wide Range Achievement Test (WRAT-III) scores (Reading, Spelling, Mathematics) between groups.
- Behavioral assessments (Achenbach Teacher's Report Form, Child Behavioral Check List) and head circumference measurements showed no significant differences between treatment and placebo groups.
Conclusions:
- Antenatal phenobarbital and repetitive antenatal corticosteroid therapy were not associated with adverse effects on intelligence, achievement, or behavior at age 7.
- These findings suggest that these antenatal interventions do not negatively impact neurodevelopmental outcomes at school age.
Objective:
To determine the effects of phenobarbital and repeated antenatal steroid use on the primary outcome (intelligence and achievement) and secondary outcomes (behavior and head circumference) at age 7 years.
Methods:
This study was a secondary analysis of a double-blind clinical trial (phenobarbital-vitamin K versus placebo). Intelligence (Wechsler Intelligence Scale for Children, third edition), achievement (Wide Range Achievement Test, third edition), and behavioral (Achenbach Teacher's Report Form and the Child Behavioral Check List) testing and head circumference measurement were performed on 7-year-old children whose mothers participated in a trial to determine if antenatal phenobarbital and vitamin K prevented severe intracranial hemorrhage. Antenatal steroid therapy in these women was repeated weekly.
Results:
Two hundred ninety-nine of 372 newborns (80%) whose mothers participated in the trial were followed up at age 7 years. Comparing mean (+/- standard deviation [SD]) Wechsler Intelligence Scale for Children scores in the placebo versus treatment groups, there were no differences (P >.4) in Full Scale IQ (100.3 +/- 14.2 versus 100.6 +/- 14.2), Performance IQ (100.3 +/- 14.6 versus 101.5 +/- 15.6), and Verbal IQ (100.2 +/- 14.9 versus 99.6 +/- 13.7). Comparing mean (+/- SD) Wide Range Achievement Test standardized scores in the placebo versus treatment groups, there were no differences (P >.4) in Reading (97.3 +/- 13.9 versus 98.0 +/- 14.9), Spelling (95.8 +/- 12.7 versus 95.3 +/- 13.3), Mathematics (95.9 +/- 13.8 versus 94.5 +/- 14.5), or head circumference measurements (20.3 +/- 0.6 cm versus 20.4 +/- 0.6, P >.2). Similarly, there were no differences in the mean Achenbach Teacher's Report Form and Child Behavioral Check List scores between the placebo and treatment groups.
Conclusion:
Antenatal phenobarbital and repetitive antenatal corticosteroid therapy was not associated with adverse effects on intelligence, achievement, behavior, or head circumference at age 7 years.