Evidence for adverse effect of perinatal glucocorticoid use on the developing brain

Area of Science:

• Neuroscience
• Developmental Biology
• Pharmacology

Background:

• Perinatal glucocorticoid (GC) exposure is linked to adverse neurodevelopmental outcomes in preterm infants.
• Antenatal GCs may affect fetal growth and head circumference.
• Postnatal GCs, especially dexamethasone, are associated with neurodevelopmental impairment and cerebral palsy in premature infants.

Purpose of the Study:

• To review the evidence on the long-term neurodevelopmental effects of perinatal glucocorticoid exposure.
• To compare the effects of different GCs, such as dexamethasone and hydrocortisone.
• To highlight the need for caution and further research on GC use in the perinatal period.

Main Methods:

• Review of clinical studies on preterm infants receiving antenatal and postnatal GCs.
• Analysis of experimental animal studies investigating GC effects on immature brains.
• Examination of long-term follow-up data for hydrocortisone therapy.

Main Results:

• Fetal exposure to excess GCs can alter the limbic system, impacting cognition, behavior, and memory.
• Dexamethasone treatment is linked to neurodevelopmental impairment, increased cerebral palsy risk, and hypomyelination due to oligodendrocyte progenitor apoptosis.
• Long-term studies on hydrocortisone therapy have not shown similar adverse neurodevelopmental effects.

Conclusions:

• Clinical and experimental evidence suggests caution is needed regarding perinatal glucocorticoid administration.
• Potential long-term effects of GCs on brain development, particularly concerning specific agents like dexamethasone, require further investigation.
• Hydrocortisone may represent a safer alternative for postnatal treatment in premature infants.