Early treatment of premature infants with steroids: neurological sequelae

Area of Science:

• Neonatal Medicine
• Pediatric Neurology
• Pharmacology

Background:

• Systemic steroids have been a standard treatment for premature infants with respiratory disorders for over 30 years.
• Concerns exist regarding immediate adverse effects and potential long-term neurological sequelae, with previous studies monitoring infants up to age 3.

Purpose of the Study:

• To evaluate the long-term neurological and developmental outcomes in premature infants treated with systemic steroids in the early postnatal period.
• To assess the safety and efficacy of postnatal steroid therapy in a randomized, placebo-controlled setting up to eight years of age.

Main Methods:

• A randomized, placebo-controlled trial involving 146 children who received systemic steroid therapy or placebo in the early postnatal period.
• Long-term follow-up of participants until eight years of age, including measurements of height, cranial circumference, and various cognitive and motor assessments.

Main Results:

• Children exposed to dexamethasone showed lower mean height (121-122 cm) compared to placebo controls (124-126 cm).
• Mean cranial circumference was smaller in the dexamethasone group (49.8 cm vs. 50.6 cm).
• Lower scores on motor, cognitive, and school examinations were observed in the dexamethasone group, with a higher incidence of disabilities (28/72 vs. 16/74).

Conclusions:

• The study confirms significant neurological adverse effects associated with prolonged postnatal systemic steroid treatment in premature infants.
• The findings strongly suggest that current steroid regimens for premature infants with respiratory disorders should be discontinued due to long-term harm.