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Published on: November 20, 2015
Preterm cerebellar growth impairment after postnatal exposure to glucocorticoids
Emily W Y Tam1, Vann Chau, Donna M Ferriero
1Departments of Neurology and Pediatrics, University of California, San Francisco, San Francisco, CA 94143, USA. emily.tam@ucsf.edu
Insights
Postnatal glucocorticoid exposure in preterm infants is linked to reduced cerebellar growth, potentially impacting cognitive development. Adjusting treatments may mitigate these neurological risks.
Area of Science:
- Neonatal medicine
- Developmental neuroscience
- Pediatric neurology
Background:
- Improving survival rates for preterm newborns has led to increased recognition of cognitive impairments.
- Reduced cerebellar volume is associated with adverse cognitive outcomes in these children.
- Perinatal glucocorticoid exposure in animal models reduces preterm cerebellar growth.
Purpose of the Study:
- To investigate the association between glucocorticoid exposure and other modifiable factors with adverse neurological outcomes in human neonates.
- To determine the impact of antenatal and postnatal glucocorticoid exposure on cerebellar volume in preterm infants.
Main Methods:
- A cohort of 172 preterm infants was studied across two medical centers.
- Serial magnetic resonance imaging (MRI) was performed near birth and term-equivalent age.
- Clinical factors were adjusted for in the analysis.
Main Results:
- Antenatal betamethasone exposure was not associated with changes in cerebellar volume after adjusting for clinical factors.
- Postnatal exposure to hydrocortisone or dexamethasone was significantly associated with impaired cerebellar growth.
- No significant impact on cerebral growth was observed with postnatal glucocorticoid exposure.
Conclusions:
- Postnatal glucocorticoid administration in preterm infants is associated with reduced cerebellar growth.
- Modifiable treatment alterations, specifically concerning postnatal glucocorticoid exposure, may reduce the risk of adverse neurological outcomes.
- Further research into optimizing neonatal care to protect cerebellar development is warranted.
Abstract:
As survival rates of preterm newborns improve as a result of better medical management, these children increasingly show impaired cognition. These adverse cognitive outcomes are associated with decreases in the volume of the cerebellum. Because animals exhibit reduced preterm cerebellar growth after perinatal exposure to glucocorticoids, we sought to determine whether glucocorticoid exposure and other modifiable factors increased the risk for these adverse outcomes in human neonates. We studied 172 preterm neonatal infants from two medical centers, the University of British Columbia and the University of California, San Francisco, by performing serial magnetic resonance imaging examinations near birth and again near term-equivalent age. After we adjusted for associated clinical factors, antenatal betamethasone was not associated with changes in cerebellar volume. Postnatal exposure to clinically routine doses of hydrocortisone or dexamethasone was associated with impaired cerebellar, but not cerebral, growth. Alterations in treatment after preterm birth, particularly glucocorticoid exposure, may help to decrease risk for adverse neurological outcome after preterm birth.
