Does corticosteroid treatment during the pre and postnatal periods affect the neurodevelopmental outcome of premature newborns?

Marita Lardón, José Uberos, Eduardo Narbona, .

Keywords: Adrenal cortex hormones, dexamethasone, betamethasone, therapeutics, premature birth, neurodevelopmental disorders

Abstract

Introduction: Glucocorticoids, widely used in the perinatal period, may be associated with adverse neurodevelopmental effects.
Objectives: To analyze neurodevelopmental outcomes in a cohort of very low birth weight newborns treated with antenatal and/or postnatal corticosteroids.
Materials and methods: This was a prospective cohort study in which we included all very low birth weight babies admitted to the neonatal intensive care unit of a tertiary hospital between 2008 and 2013. We compared the neurodevelopment among very low birth-weight newborns who did not receive prenatal corticosteroid therapy and those who received a complete course (two doses of 12 mg betamethasone) and an incomplete course (one dose), and between those who did not receive postnatal corticosteroid therapy and those who received it (systemic dexamethasone after the first week of life). Motor, neurosensory and cognitive functions, as well as behavior disorders during the first two years of age were evaluated.
Results: A total of 225 very low birth weight newborns were analyzed; 83.6% received prenatal corticosteroid therapy (24% incomplete treatment schedule and 59.6% complete schedule). Only 13.3% received systemic dexamethasone during the postnatal period. Neurological monitoring was performed corticosteroid therapy and more neurological disorders, and no significant differences were found among those who received complete and incomplete courses of prenatal corticosteroid therapy.
Conclusion: These results did not demonstrate an association between perinatal corticosteroid therapy and worse neurodevelopmental outcomes in very low birth weight newborns.

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  • Marita Lardón Servicio de Pediatría, Hospital Universitario San Cecilio, Granada, España
  • José Uberos Servicio de Pediatría, Hospital Universitario San Cecilio, Granada, España
  • Eduardo Narbona Servicio de Pediatría, Hospital Universitario San Cecilio, Granada, España

References

Barrington KJ. The adverse neuro-developmental effects of postnatal steroids in the preterm infant: A systematic review of RCTs. BMC Pediatr. 2001;1:1. http://dx.doi.org/10.1186/1471-2431-1-1

Shinwell ES, Karplus M, Reich D, Weintraub Z, Blazer S, Bader D, et al. Early postnatal dexamethasone treatment and increased incidence of cerebral palsy. Arch Dis Child Fetal Neonatal. 2000;83:F177-81. http://dx.doi.org/10.1136/fn.83.3.F177

Murphy BP, Indur TE, Huppi PS, Warfield S, Zientara GP, Kikinis R, et al. Impaired cerebral cortical gray matter growth after treatment with dexamethasone for neonatal chronic lung disease. Pediatrics. 2001;107:217-21.

American Academy of Pediatrics Committee on Fetus and Newborn and Canadian Paediatric Society, Fetus and Newborn Committee. Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants. Pediatrics. 2002;109:330-8.

Walsh MC, Yao Q, Horbar JD, Carpenter JH, Lee SK, Ohlsson A. Changes in the use of postnatal steroids for bronchopulmonary dysplasia in 3 large neonatal networks. Pediatrics. 2006;118:e1328-35.

Yoder BA, Harrison M, Clark RH. Time-related changes in steroid use and bronchopulmonary dysplasia in preterm infants. Pediatrics. 2009;124:673-9.

Cheong JL, Anderson P, Roberts G, Duff J, Doyle LW, Victorian Infant Collaborative Study Group. Postnatal corticosteroids and neurodevelopmental outcomes in extremely 15 year experience in Victoria, Australia. Arch Dis Child Fetal Neonatal Ed. 2013;98:F32-6. http://dx.doi.org/10.1136/fetalneonatal-2011-301355.

Tapia JL, Kattan J. Corticoides postnatal y displasia broncopulmonar: beneficios versus riesgos. Rev Chil Pediatr. 2003;74:70-80. http://dx.doi.org/10.4067/S0370-

Doyle LW, Ehrenkranz RA, Halliday HL. Early (<8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2014;5:CD001146. http://dx.doi.org/10.1002/14651858.CD001146.pub4

Halliday HL, Ehrenkranz RA, Doyle LW. Early (<8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2010;1:CD001146. http://dx.doi.org/10.1002/14651858.CD001146.pub3

Doyle LW, Ehrenkranz RA, Halliday HL. Postnatal hydrocortisone for preventing or treating bronchopulmonary dysplasia in preterm infants: A systematic review. Neonatology. 2010;98:111-7. http://dx.doi.org/10.1159/000279992

Doyle LW, Ehrenkranz RA, Halliday HL. Late (>7 days) postnatal corticosteroids for chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2014;5:CD001145. http://dx.doi.org/10.1002/14651858.CD001145.pub3

Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006;3:CD004454. http://dx.doi.org/10.1002/14651858.CD004454.pub2

Romejko-Wolniewicz E, Teliga-Czajkowska J, Czajkowski K. Antenatal steroids: Can we optimize the dose? Curr Opin Obstet Gynecol. 2014;26:77-82. http://dx.doi.org/10.1097/GCO.0000000000000047

Carrascosa A, Ferrández A, Yeste D, García-Dihinx J, Romo A, Copil A, et al. Spanish cross-sectional growth study 2008. Part I: Weight and height values in newborns of 26-42weeks of gestational age. An Pediatr (Barc). 2008;68:544-51.

Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723-9. http://dx.doi.org/10.1164/ajrccm.163.7.2011060

Young TE, Mangum B. Neofax: Manual de drogas neonatológicas. 18 edición. Madrid: Panamericana; 2006.

Stark AR, Carlo WA, Vohr BR, Papile CA, Saha S, Baver CR. Death or neurodevelopmental impairment at 18 to 22 months corrected age in a randomized trial of early dexamethasone to prevent death or chronic lung disease in extremely low birth weight infants. J Pediatr. 2014;164:34-9. http://dx.doi.org/10.1016/j.jpeds.2013.07.027

O´Shea TM, Washburn LK, Nixon PA, Goldstein DJ. Follow-up of a randomized placebo-controlled trial of dexamethasone to decrease the duration of ventilator dependency in very low birth weight infants: Neurodevelopmental outcomes at 4 to 11 years of age. Pediatrics. 2007;120:594-602.

Needelman H, Evans M, Roberts H, Sweney M, Bodensteiner JB. Effects of postnatal dexamethasone exposure on the developmental outcome of premature infants. J Child Neurol. 2008;23:421-4. http://dx.doi.org/10.1177/0883073807309232

Wilson-Costello D, Walsh MC, Langer JC, Guillet R, Laptook AR, Stoll BJ. Impact of postnatal corticosteroid use on neurodevelopment at 18 to 22 months´adjusted age: Effects of dose, timing, and risk of bronchopulmonary dysplasia in extremely low birth weight infants. Pediatrics. 2009;123:e430-7. http://dx.doi.org/10.1542/peds.2008-1928.

Lim G, Lee BS, ChoiYS, Park HW, Chung ML, Choi HJ, et al. Delayed dexamethasone therapy and neurodevelopmental outcomes in preterm infants with bronchopulmonary dysplasia. Pediatr Neonatol. 2015;56:261-7. http://dx.doi.org/10.1016/j.pedneo.2014.11.006

Onland W, Offringa M, DeJaegere AP, van Kaam AH. Finding the optimal postnatal dexamethasone regimen for preterm infants at risk of bronchopulmonary dysplasia: A systematic review of placebo-controlled trials. Pediatrics. 2009;123:367-77. http://dx.doi.org/10.1542/peds.2008-0016

Onland W, De Jaegere AP, Offringa M, van Kaam AH. Effects of higher versus lower dexamethasone doses on pulmonary and neurodevelopmental sequelae in preterm infants at risk for chronic lung disease: A meta-analysis. Pediatrics. 2008;122:92-101. http://dx.doi.org/10.1542/peds.2007-2258

Gupta S, Prasanth K, Chen CM, YehTF. Postnatal corticosteroids for prevention and treatment of chronic lung disease in the preterm newborn. Int J Pediatr. 2012;2012:315642. http://dx.doi.org/10.1155/2012/315642

Jarreau PH, Fayon M, Baud O, Autret-Leca E, Danan M, de Verdelhan A, et al. The use of postnatal corticosteroid therapy in premature infants to prevent or treat bronchopulmonary dysplasia: Current situation and recommendations. Arch Pediatr. 2010;17:1480-7. http://dx.doi.org/10.1016/j.arcped.2010.07.013

Sotiriadis A, Tsiami A, Papatheodorou S, Baschat AA, Sarafidis K, Makrydimas G. Neurodevelopmental outcome after a single course of antenatal steroids in children born preterm: A systematic review and meta-analysis. Obstet Gynecol. 2015;125:1385-96. http://dx.doi.org/10.1097/AOG.0000000000000748

Miyazaki K, Furuhashi M, Ishikawa K, Tamakoshi K, Hayashi K, Kai A. Long-term outcomes of antenatal corticosteroids treatment in very preterm infants after chorioamnionitis. Arch Gynecol Obstet. 2015;292:1239-46.http://dx.doi.org/10.1007/s00404-015-3762-6

Eriksson L, Haglund B, Ewald U, Odlind V, Kieler H. Short and long-term effects of antenatal corticosteroids assessed in a cohort of 7827 children born preterm. Acta Obstet Gynecol Scand. 2009;88:933-8. http://dx.doi.org/10.1080/00016340903111542

Wong D, Abdel-Latif M, Kent A, NICUS Network. Antenatal steroid exposure and outcomes of very premature infants: A regional cohort study. Arch Dis Child Fetal Neonatal Ed. 2014;99:F12-20. http://dx.doi.org/10.1136/archdischild-2013-304705

Chawla S, Bapat R, Pappas A, Bara R, Zidan M. Neurodevelopmental outcome of extremely premature infants exposed to incomplete, no or complete antenatal steroids. J Matern Fetal Neonatal Med. 2013;26:1542-7. http://dx.doi.org/10.3109/14767058.2013.791273

Lee BH, Stoll BJ, McDonald SA, Higgins RD, National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental outcomes of extremely low birth weight infants exposed prenatally to dexamethasone versus betamethasone. Pediatrics. 2008;121:289-96. http://dx.doi.org/10.1542/peds.2007-1103

Brownfoot FC, Gagliardi DI, Bain E, Middleton P, Crowther CA. Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2013;CD006764. http://dx.doi.org/10.1002/14651858.CD006764.pub3

How to Cite
1.
Lardón M, Uberos J, Narbona E. Does corticosteroid treatment during the pre and postnatal periods affect the neurodevelopmental outcome of premature newborns?. biomedica [Internet]. 2017 Apr. 1 [cited 2024 May 13];37(Sup.1):104-11. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/3394

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Published
2017-04-01

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