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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.
Insights
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.
Objective:
The objective was to study the effects of repeated antenatal corticosteroids on birth size, growth, and development in preterm infants.
Study Design:
This observational study followed up for 3 years a prospective geographic cohort in the state of Western Australia of 477 singleton infants born at <33 weeks' gestation.
Results:
Birth weight ratio decreased with increasing number of corticosteroid courses (P =.001), and multivariate analyses confirmed a reduction in birth weight of as much as 9% (P =.014) and a reduction in head circumference of as much as 4% (P =.0024). There were no additional benefits in mortality or respiratory outcomes, and there was a trend toward more severe chronic lung disease. At age 3 years growth and severe disability outcomes did not appear to be related to increasing number of corticosteroid courses.
Conclusions:
In this cohort study repeated corticosteroid courses were associated with adverse effects on size at birth without apparent benefits. These changes have the potential to affect later development.