Perinatal corticosteroids: A review of research. Part I: Antenatal administration

Area of Science:

• Neonatal Medicine
• Pharmacology
• Developmental Neuroscience

Background:

• Premature infants often receive therapeutic glucocorticoids antenatally or postnatally.
• Corticosteroids are increasingly prescribed before and after birth over the past 30 years.
• Understanding benefits and risks to fetuses and neonates is vital for clinical practice.

Purpose of the Study:

• To discuss the benefits and risks of antenatal corticosteroids (ACS) for premature infants.
• To review historic and pharmacokinetic information regarding prenatal corticosteroid use.
• To present scientific evidence from animal models and clinical trials on ACS benefits and risks.

Main Methods:

• Review of numerous clinical studies on therapeutic steroid use for respiratory distress syndrome and chronic lung disease prevention.
• Analysis of research in newborn animal models focusing on timing, duration, and dosage of ACS and postnatal corticosteroids (PCS).
• Examination of current clinical research on infant neurodevelopment following therapeutic exposure to perinatal corticosteroids.

Main Results:

• Research results on the efficacy of repeated steroid exposure in premature infants vary.
• Potential for neurologic side effects in premature infants exposed to repeated ACS and/or high-dose PCS may manifest later in life.
• Ongoing research aims to identify safer minimal dose protocols for perinatal corticosteroid therapy.

Conclusions:

• Antenatal corticosteroids (ACS) provide significant benefits for premature infants, particularly in preventing respiratory distress syndrome and chronic lung disease.
• However, concerns exist regarding potential long-term neurologic side effects, especially with repeated or high-dose exposure.
• Further research and careful consideration of dosing strategies are essential to optimize the use of perinatal corticosteroids in neonatal clinical practice.