Review of the antenatal and postnatal use of steroids

Area of Science:

• Neonatal Medicine
• Pharmacology
• Pediatric Critical Care

Background:

• Corticosteroids are crucial in managing premature infants, particularly for respiratory distress syndrome (RDS).
• Antenatal steroid administration is a widely adopted practice with proven benefits.
• Postnatal dexamethasone use in ventilated infants requires caution due to potential long-term neurodevelopmental complications.

Purpose of the Study:

• To review the role of antenatal and postnatal corticosteroids in premature infant management.
• To discuss the benefits and risks associated with dexamethasone therapy.
• To explore alternative corticosteroid therapies, such as hydrocortisone.

Main Methods:

• Literature review of studies on antenatal and postnatal corticosteroid use in preterm neonates.
• Analysis of the impact of corticosteroids on RDS, intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP).
• Evaluation of neurodevelopmental outcomes associated with postnatal dexamethasone and potential alternatives.

Main Results:

• Antenatal corticosteroids significantly reduce RDS incidence and severity, and may decrease IVH, PDA, NEC, and ROP.
• Postnatal dexamethasone use is associated with concerns regarding long-term neurodevelopmental complications.
• Hydrocortisone is emerging as a potential alternative with favorable initial long-term evaluations.

Conclusions:

• Antenatal corticosteroids are essential for improving outcomes in premature infants.
• Careful consideration of risks and benefits is needed for postnatal dexamethasone, prompting research into alternatives.
• Hydrocortisone shows promise as a safer alternative for postnatal corticosteroid therapy in preterm infants.