Cumulative Perinatal Steroids: Child Development of Preterm Infants

Abstract

The development of premature infants may be altered due to exposure to high cumulative doses of the perinatal corticosteroid dexamethasone during critical growth periods. To compare child behavioral development of prematurely born infants who were exposed to higher perinatal steroids (PNS; N0.2 mg/kg) with that of infants exposed to lower PNS (≤0.2 mg/kg), we used the Vineland Adaptive Behavioral Scales to assess school-age behavioral outcomes of a historical cohort of 45 prematurely born infants. Children who had received higher PNS treatment were more likely to have lower overall behavioral developmental scores, especially lower social skills (p < .05). Higher PNS plus higher severity of illness during the first day of life based on the Clinical Risk Index for Babies (p = .016) and lower birth head size (p = .015) were linked with poorer behavioral outcomes among participants. Nursing practice includes promotion of quality care and should include closer evaluation of cumulative steroid therapy, severity of illness, and promotion of long-term follow-up support for premature infants. KeywordsPerinatal steroids; Dexamethasone; Preterm infants; Neurodevelopment PRETERM DELIVERY, ESTIMATED to occur in 7-11% of all North American births, is responsible for 75% of neonatal deaths (National Institutes of Health [NIH] Consensus Development Conference Statement, 1994). The outcomes of preterm infant survival are often dependent upon the provision of high-quality perinatal care, prior to 40 weeks' postconceptual age, as this is a vulnerable time in development. Over the past 30 years, synthetic or exogenous steroids have increasingly been prescribed before and after birth with the intent to improve infant lung maturity and outcomes. The 1994 NIH consensus panel recommendation for antenatal steroids (before birth) consisted of two doses of 12 mg of betamethasone given intramuscularly at 24-hour intervals or four doses of 6 mg of dexamethasone given intramuscularly at 12-hour intervals. In 2000, the panel revisited this recommendation and discouraged the use of multiple-course antenatal steroids because studies identified associations between steroids and impaired infant head growth and neurodevelop-mental outcomes (National Institutes of Health, 2000 Although commonly given for a variety of therapeutic reasons in perinatal care, the risks may not outweigh the benefits of either higher antenatal or postnatal steroid exposure. Perinatal steroids (PNS) are primarily administered for the promotion of infant lung maturation and reduction of respiratory distress syndrome and mortality (Huang, Dunlop, & Harper, 1999). Many premature infants have received multiple doses of therapeutic steroid drugs while in utero as well as in the postnatal period.Studies have retrospectively examined either antenatal or postnatal steroid effects . This study was the first to retrospectively identify the precise milligram amount of cumulative PNS dosed prior to 40 weeks and prospectively examine relationships with neurodevelopment of pre...

Differential subcellular localization of the glucocorticoid receptor in distinct neural stem and progenitor populations of the mouse telencephalon in vivo

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A Psychoneuroimmunologic Examination of Cumulative Perinatal Steroid Exposures and Preterm Infant Behavioral Follow-Up

“…Clearly developmental assessment of the interplay between behavioral problems and motor, cognitive, and/or language skills is valuable to this research. In the present study, we examined developmental scores from our prior research with the Vineland Adaptive Behavioral Scales in our current regressions (see Table 5) and found no statistically significant associations (Purdy et al, 2008; Sparrow, Balla, & Cicchetti, 1984). …”

“…Regression for Internalizing Problems scale: R 2 = .51, Δ R 2 = .42; for Total Competence scale: R 2 = .84, Δ R 2 = .73); and for Total Problems scale: R 2 = .950, Δ R 2 = .92. CRIB = Clinical Risk Index for Babies; NICU = neonatal intensive care unit; PNS = perinatal steroid; VABS = Vineland Adaptive Behavior scales. a VABS data from prior study (Purdy, 2008). …”

Follow-Up de Nascidos Prematuros: Uma Revisão Sistemática da Literatura

“…A partir desta configuração, a subcategoria 1c destacouse das demais, indicando que 50% (f = 24) dos estudos realizaram o follow-up de prematuros entre o nascimento e a adolescência (Berbis et al, 2012;Bohm & Katz-Salamon, 2003;Brown et al, 2014;Caravale et al, 2012;Charkaluk et al, 2012;Claas et al, 2011;Cooke, 2006;Doyle et al, 2012;Feldman, 2009;Gurka et al, 2010;Halbwachs et al, 2014;Jongmans et al, 1993;Korja et al, 2014;Leppänen et al, 2014;Leversen et al, 2012;Lind et al, 2010;Luu et al, 2011;Munck et al, 2012;Nepomnyaschy et al, 2012;Purdy et al, 2008;Rodriguez et al, 2011;Schothorst et al, 2007;Schepers et al, 2012;Treyvaud et al, 2013). A seguir, tem-se a subcategoria 1a, na qual 27,08% (f = 13) dos artigos avaliaram os prematuros entre o nascimento e os 36 meses de vida (Fraga et al, 2008;Gabis et al, 2015;Houtzager et al, 2010;Katz-Salamon et al, 2000;Khan et al, 2008;Newnham et al, 2009;Petit et al, 2016;Pineda et al, 2014;Pinto, 2009;Poggioli et al, 2016;Ross et al, 2016;Stolt et al, 2014;Voigt et al, 2013).…”

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