Multiple courses of antenatal steroids

Area of Science:

• Neonatal Medicine
• Perinatology
• Endocrinology

Background:

• The optimal use of antenatal steroids (ANS) for preterm infants remains a critical clinical question.
• Concerns exist regarding potential risks of multiple ANS courses, including adrenal suppression and developmental effects.

Purpose of the Study:

• To evaluate the benefits and risks of multiple antenatal dexamethasone courses on neonatal outcomes and long-term development.
• To assess adrenal function, neonatal morbidity, and neurodevelopmental status in preterm infants exposed to varying numbers of ANS courses.

Main Methods:

• A prospective cohort study included preterm infants (<= 35 weeks gestation) in a level III neonatal unit.
• Infants were categorized by the number of antenatal dexamethasone courses received (0, 1, 2, >2).
• Key outcomes included adrenal function (cortisol levels), neonatal morbidity (e.g., HMD), birth parameters, and neurodevelopmental assessments at 22 months.

Main Results:

• No significant differences in basal or post-ACTH cortisol levels were observed between groups, indicating no adrenal suppression.
• Multiple ANS courses (>=2) were associated with a significantly lower incidence of severe HMD requiring ventilation compared to a single course.
• No differences were found in other neonatal morbidities, birth anthropometrics, or neurodevelopmental outcomes (neurological examination, PDI, MDI) at follow-up.

Conclusions:

• Multiple courses of antenatal dexamethasone effectively reduce severe respiratory distress syndrome in preterm infants.
• This treatment strategy does not appear to cause adrenal suppression, impair growth, or negatively affect neurodevelopmental outcomes.