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Repeated antenatal corticosteroids: size at birth and subsequent development
N P French1, R Hagan, S F Evans
1Department of Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Australia.
American Journal of Obstetrics and Gynecology
|January 23, 1999
Summary
Repeated antenatal corticosteroids in preterm infants reduced birth size but showed no benefits in mortality or respiratory outcomes. Long-term growth and disability were not affected by multiple courses.
Area of Science:
- Neonatal Medicine
- Pediatric Endocrinology
- Developmental Pediatrics
Background:
- Antenatal corticosteroids are crucial for preterm infant lung maturation.
- The impact of repeated courses on long-term outcomes requires further investigation.
Purpose of the Study:
- To assess the effects of repeated antenatal corticosteroid administration on birth size, postnatal growth, and neurodevelopmental outcomes in preterm infants.
- To determine if multiple courses of antenatal corticosteroids are associated with adverse effects.
Main Methods:
- Observational cohort study of 477 singleton infants born before 33 weeks' gestation in Western Australia.
- Follow-up for 3 years to evaluate growth and severe disability outcomes.
- Analysis of birth weight and head circumference in relation to the number of corticosteroid courses received.
Main Results:
- A significant decrease in birth weight ratio with increasing corticosteroid courses (P=.001).
- Multivariate analysis revealed up to a 9% reduction in birth weight (P=.014) and 4% in head circumference (P=.0024).
- No benefits in mortality or respiratory outcomes; a trend towards more severe chronic lung disease was observed.
Conclusions:
- Repeated antenatal corticosteroid courses are linked to reduced birth size without clear benefits.
- Adverse effects on early size may have implications for later development, though 3-year outcomes were not significantly impacted.
- Further research is needed to optimize antenatal corticosteroid use in preterm pregnancies.