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The use and abuse of steroids in perinatal medicine
1Department of Neonatology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899. samuel@kkh.com.sg
Insights
A single antenatal corticosteroid course benefits premature infants by reducing respiratory distress syndrome and mortality. However, multiple courses and postnatal steroids may pose risks, necessitating further research on long-term neurodevelopmental outcomes.
Area of Science:
- Neonatal Medicine
- Pharmacology
- Developmental Pediatrics
Background:
- Corticosteroids are widely used in perinatal and neonatal care.
- Their benefits and risks require careful evaluation for optimal patient outcomes.
Purpose of the Study:
- To review the advantages and disadvantages of antenatal and postnatal corticosteroid use.
- To identify areas needing further research regarding corticosteroid therapy in neonates.
Main Methods:
- Systematic review of existing literature on corticosteroid use in perinatal and neonatal periods.
- Analysis of data from animal and human studies on antenatal and postnatal steroid administration.
Main Results:
- A single antenatal corticosteroid course significantly reduces respiratory distress syndrome, intraventricular hemorrhage, neonatal mortality, and cerebral palsy.
- Multiple antenatal courses and postnatal systemic steroids may be associated with adverse neurodevelopmental outcomes and reduced organ weights.
- Postnatal steroids can improve survival and reduce chronic lung disease in some infants.
Conclusions:
- A single course of antenatal glucocorticoids is recommended for women at risk of preterm delivery.
- Further randomized controlled trials are essential to clarify the effects of multiple antenatal corticosteroid courses and long-term neurodevelopmental outcomes of both antenatal and postnatal therapies.
Abstract:
Corticosteroids are one of the most powerful drugs increasingly used in the perinatal and neonatal period. This review discusses the merits and demerits of antenatal as well as postnatal use of steroids. A single course of antenatal corticosteroids in women at risk of premature delivery is highly effective in reducing respiratory distress syndrome (RDS), intraventricular haemorrhage and neonatal mortality and also neurodevelopmental sequelae including cerebral palsy. However, there is less evidence to support the practice of multiple courses of corticosteroids, with some animal and retrospective human studies suggesting an association with neurological impairment and reduction in birth weight as well as lung weight. Postnatal systemic corticosteroids have shown benefits in reducing chronic lung disease and improving survival for infants. However, besides short-term adverse effects, the follow-up studies have raised concern that they may increase the risk of neurodevelopmental disability, particularly cerebral palsy in survivors. Systemic corticosteroids may have a role in infants who had repeated and prolonged intubations and those with pressor-resistant hypotension. Alternative strategies for prevention of chronic lung disease, such as inhaled steroids, methylprednisolone and hydrocortisone, may need further studies with larger sample sizes. Data from animal research have revealed that fetal glucocorticoid exposure may have a role in programming the individual to adult degenerative diseases. Based on the current evidence, it is recommended that women at risk of preterm delivery receive a single course of glucocorticoids. Randomised controlled trials are needed to establish the true effects of multiple courses of antenatal corticosteroids. More research is also needed to study the long-term neurodevelopmental outcome of both multiple courses of antenatal corticosteroids, as well as postnatal corticosteroid therapy.