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Use of steroids in the perinatal period.

Abstract：

INTRODUCTION:Corticosteroids can be used prenatally to mature the fetal lungs and postnatally to treat or prevent chronic lung disease (CLD). Randomised controlled trials have been performed to evaluate the benefits and risks of perinatal corticosteroid therapy. METHODS:Systematic reviews of randomised controlled trials of prenatal and postnatal corticosteroids in the Cochrane Library were examined to determine the cost-benefit ratios of treatment. Outcomes are given as numbers needed to treat (NNT) or numbers needed to harm (NNH) with 95% confidence intervals (CI). RESULTS:Prenatal corticosteroids reduce the risk of RDS (NNT 11; 95% CI 9-16), surfactant use (NNT 9; 95% CI 5-62), intraventricular haemorrhage (NNT 9; 95% CI 6-19) and neonatal mortality (NNT 23; 95% CI 16-42). There are no short-term or long-term adverse effects of a single course of prenatal betamethasone. However, repeated courses of prenatal steroids could be harmful and should be avoided outside of a randomised controlled trial. Postnatal corticosteroids can be used to prevent CLD (early use) or to treat it (late use). Beneficial effects include earlier extubation (typical NNT 5; 95% CI 4-10), reduced CLD (typical NNT 10; 95% CI 8-17) and avoidance of late steroids (NNT 7; 95% CI 6-10). However, there are significant adverse short-term effects such as hyperglycaemia (typical NNH 8; 95% CI 6-10), hypertension (typical NNH 10; 95% CI 8-14). Hy- pertrophic cardiomyopathy (typical NNH 5; 95% CI 4-11), gastrointestinal bleeding (typical NNH 17; 95% CI 11-33) and growth failure (NNH 2; 95% CI 1-2). More important are long-term adverse effects of cerebral palsy (typical NNH 8; 95% CI 6-17), developmental delay (typical NNH 7; 95% CI 4-33) and abnormal neurological examination (typical NNH 4; 95% CI 2-14). These adverse effects are more pronounced with early (<96 h) treatment but probably also occur when steroids are given later in the postnatal period. CONCLUSIONS:A single course of prenatal betamethasone has clear benefits for the fetus who is likely to be born preterm but repeated courses may be harmful. Postnatal steroids should be avoided if at all possible. They might be indicated in very low doses for ventilator-dependent infants who might otherwise die without them.

journal_name

Paediatr Respir Rev

journal_title

Paediatric respiratory reviews

authors

Halliday HL

doi

10.1016/s1526-0542(04)90057-7

keywords:

subject

Has Abstract

pub_date

2004-01-01 00:00:00

pages

S321-7

eissn

1526-0542

issn

1526-0550

pii

S1526054204900577

journal_volume

5 Suppl A

pub_type

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Use of steroids in the perinatal period.