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Current evidence for prenatal and postnatal corticosteroids in preterm infants
Eric S Shinwell1,2, Polina Gurevitz3, Igor Portnov3
1Neonatology, Ziv Medical Center, Tzfat, Israel eric.s@ziv.health.gov.il.
Insights
Antenatal corticosteroids improve infant outcomes, but updated dosing may be beneficial. Research explores alternatives to systemic dexamethasone for preventing bronchopulmonary dysplasia.
Area of Science:
- Neonatal medicine
- Pharmacology
- Pulmonology
Background:
- Antenatal corticosteroids are crucial for neonatal survival and health.
- Current dosing schedules have remained unchanged since 1972.
- Emerging evidence suggests lower doses may suffice, with most long-term studies showing no adverse effects.
Purpose of the Study:
- To review the current evidence on antenatal corticosteroid use, including in COVID-19.
- To explore alternative postnatal corticosteroid therapies for preventing bronchopulmonary dysplasia.
- To highlight promising areas for future research in corticosteroid treatment.
Main Methods:
- Review of recent studies on antenatal corticosteroid efficacy and safety.
- Analysis of long-term outcome data.
- Evaluation of alternative postnatal corticosteroid strategies.
Main Results:
- Antenatal corticosteroids significantly improve neonatal outcomes.
- Lower doses of antenatal corticosteroids may offer similar benefits.
- Alternatives like systemic hydrocortisone and inhaled corticosteroids show promise for preventing bronchopulmonary dysplasia without adverse effects.
Conclusions:
- Current antenatal corticosteroid guidelines should be critically reviewed for potential optimization.
- Alternative postnatal corticosteroid therapies warrant further investigation.
- The combination of surfactant and corticosteroids is a key area for future research.
Abstract:
Antenatal corticosteroids undoubtedly save many lives and improve the quality of many others. However, the currently accepted dosage schedule has been in place since 1972, and recent studies have suggested that beneficial effects may be seen with less. Most but not all studies of long-term outcome show no adverse effects. The use of antenatal corticosteroids in women with COVID-19 raises important questions regarding potential risks and benefits. However, currently, most authorities recommend continuing according to published guidelines. With regard to postnatal corticosteroids, alternatives to systemic dexamethasone, the somewhat tainted standard of care, show promise in preventing bronchopulmonary dysplasia without adverse effects. Systemic hydrocortisone and inhaled corticosteroids are of note. The mixture of surfactant and corticosteroids deserves particular attention in the coming years.
