Does serial versus single course betamethasone therapy increase neonatal morbidity

Debbs, Robert H.; Abbasi, Saeed; Tolosa, Jorge; Weiner, Scott A; Wapner, Ronald J.

doi:10.1016/s0002-9378(97)80199-8

Cited by 7 publications

(2 citation statements)

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“…15 Multiple injections of prenatal steroids have also results in an irreversible degeneration of hippocampal neurons in primates. 23 Human studies dealing with the effects of multiple doses of prenatal steroids have reported improved outcome for intraventricular hemorrhage and respiratory distress syndrome, 1317 but increased incidence of necrotizing enterocolitis and sepsis, 16 ' 21 placental insufficiency and dysfunction, 18 and neonatal cushingoid syndrome. 24 No adverse cardiac effects have been reported in humans although some animal studies indicate that prenatal steroid treatment may affect fetal cardiac development resulting in larger heart/body weight ratio and higher proliferative index.…”

Section: Discussionmentioning

confidence: 99%

Transient Hypertrophic Cardiomyopathy in the Newborn Following Multiple Doses of Antenatal Corticosteroids

Yunis¹,

Bitar²,

Hayek³

et al. 1999

Amer J Perinatol

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Postnatal exposure to steroids has been associated with hypertrophic cardiomyopathy (HCM) in the newborn. Such an effect has not been described in infants born to mothers who received antenatal steroids. We report three newborns whose mothers were treated with betamethasone prenatally in different doses, duration of time, and who developed various degrees of HCM diagnosed by echocardiography. There was no maternal evidence of diabetes except for one infant whose mother had a normal fasting and post-prandial blood glucose prior to steroid therapy, but an abnormal one hour postprandial glucose after 8 weeks of betamethasone therapy, with a normal HbA1 C level. There was no family history of HCM, no history of maternal intake of other relevant medications, and no hypertension in all three newborns. Follow-up echocardiography revealed complete resolution of the HCM changes in all infants. We suggest that repeated antenatal maternal steroid intake may cause changes of HCM in the newborn. These changes appear to be dose- and duration-related and are mostly reversible. Further prospective controlled studies to evaluate these observations and to investigate potential mechanisms are warranted.

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Section: Discussionmentioning

confidence: 99%

Transient Hypertrophic Cardiomyopathy in the Newborn Following Multiple Doses of Antenatal Corticosteroids

Yunis¹,

Bitar²,

Hayek³

et al. 1999

Amer J Perinatol

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“…The evidence, however, both from animal and human studies is conflicting. Some reports suggest a decreased incidence of adverse neonatal outcomes and others suggest harmful effects 1–3 . One reason for this is that observational studies are unable to separate the effect of multiple courses from either the influence of different gestational ages at delivery or the disorder for which multiple courses were prescribed.…”

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Authors' Reply

Brocklehurst¹,

Alfirevic

Chamberlain

2000

BJOG

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Antenatal corticosteroid therapy and risk of osteoporosis. Br J Obsret Gynaecol1998; 105 551-555. Spencer C, Smith P, Rafla N, Weatherell R. Corticosteroids in pregnancy and osteonecrosis of the femoral head. Obster Gynecof. In press. French N, Hagan R, Evans S , Godfrey M, Newnham J. Repeated antenatal corticosteroids: size at birth and subsequent development. Am J Obsret Gynecoll999; 180: 114-121. Turnentine M, Dupras-Wilson P, Wilkins 1. A retrospective analysis of the effect of antenatal steroid administration on the incidence of respiratory distress syndrome in preterm twin pregnancies. Am J Perinarol Ardila J, LeGuennec J, Papageorgiou A. Influence of antenatal betamethasone and gender cohabitation on outcome of twin pregnancies 24 to 34 weeks of gestation. Semin Perinatall994; 18: 15-18. Garite J, Rumney P, Briggs G. A randomized placebo-controlled trial of betamethasone for the prevention of respiratory distress syndrome at 24 to 28 weeks' gestation. Am J Obstet Gynecoll992; 166: 646-65 1. 1996; 13: 351-354. Sir; We are pleased that our paper on the use of repeated courses of corticosteroids in the UK has stimulated further discussion as this is obviously an important topic for current obstetric practice. We agree with Spencer and Pakarian that adverse effects have been reported in babies whose mothers have received multiple courses of corticosteroids. The evidence, however, both from animal and human studies is conflicting. Some reports suggest a decreased incidence of adverse neonatal outcomes and others suggest harmful effects'-g. One reason for this is that observational studies are unable to separate the effect of multiple courses from either the influence of different gestational ages at delivery or the disorder for which multiple courses were prescribed. As the authors point out, women who received multiple courses of steroids are more likely to be delivered at later gestations when risk of neonatal respiratory distress and other premature complications are uncommon. However, it can also be argued that women who receive multiple courses of corticosteroids remain in an at-risk situation for longer and this in itself may be associated with a worse perinatal outcome. Without a randomised controlled trial the relative contribution of these two biases cannot be known. AUTHORS' REPLYAs our survey of practice showed, 98% of units that responded to the survey in the UK currently prescribe multiple courses of corticosteroids to some women. Whether this confers benefit, causes harm or has no effect on the condition of these babies is currently unknown and unlike Spencer and Pakarian we argue that not to do a randomised controlled trial is unethical. While waiting for the results of this trial it is not possible to recommend the number of courses of corticosteroids that may or may not be beneficial or harmful. This information can only come from a well-designed randomised controlled trial. There is no other methodology which can produce a bias-free answer.Finally Spencer and Pakarian are concerned that a t...

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Outcomes of children of extremely low birthweight and gestational age in the 1990's

Hack

Fanaroff

1999

Early Human Development

505

221

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Does serial versus single course betamethasone therapy increase neonatal morbidity

Cited by 7 publications

References 0 publications

Transient Hypertrophic Cardiomyopathy in the Newborn Following Multiple Doses of Antenatal Corticosteroids

Transient Hypertrophic Cardiomyopathy in the Newborn Following Multiple Doses of Antenatal Corticosteroids

Authors' Reply

Outcomes of children of extremely low birthweight and gestational age in the 1990's

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