Elsevier

Seminars in Neonatology

Volume 6, Issue 4, August 2001, Pages 293-307
Seminars in Neonatology

Regular Articles
Perinatal glucocorticoid therapy and neurodevelopmental outcome: an epidemiologic perspective

https://doi.org/10.1053/siny.2001.0065Get rights and content

Abstract

A relatively brief course of antenatal glucocorticoids (ACS), given to reduce the severity of respiratory distress syndrome in preterm infants, improves survival and appears to protect against brain damage. In clinical trials as well as observational studies, ACS have been associated with a decreased risk of intraventricular haemorrhage and cerebral palsy. In observational studies a decreased risk of white-matter damage, identified with cranial ultrasound, has been observed. There is some evidence, from observational studies, that repeated courses of ACS (typically given at weekly intervals) can reduce the rate of fetal head growth, and experiments in animals provide further support for this possibility. In contrast to the effects of a brief course of ACS, postnatal glucocorticoids (PCS), given to preterm infants to reduce the severity of chronic lung disease have been associated with an increased risk of neurologic impairment. Available evidence suggests that PCS does not improve survival. Further study is needed of the neurodevelopmental consequences of both multiple courses of ACS, as well as PCS.

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    Correspondence to: T. Michael O'Shea, MD, MPH, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA. Tel.: +1 336-716-2529; Fax: +1 336-716-2525; E-mail:[email protected]

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