Effects of antenatal corticosteroid administration on mortality and long-term morbidity in early preterm, growth-restricted infants

Schaap, A. H. P.; Wolf, Hans; Bruinse, Hein W.; Haas, Hetty Smolders-de; Ertbruggen, Ingrid van; Treffers, P.E.

doi:10.1016/s0029-7844(01)01343-6

Cited by 56 publications

(53 citation statements)

References 29 publications

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“…Another case control study looked at long-term outcomes of preterm infants with growth restriction secondary to placental insufficiency. 28 Of 124 infants born between 26 and 32 weeks gestation survival without disability or handicap at two years of age was higher in the corticosteroid group than matched controls. Conversely, a recent systematic review of antenatal corticosteroid therapy for growth-restricted, preterm infants concluded that treatment has no effect on neonatal morbidity or mortality in this population.…”

Section: Efficacy In Special Patient Populationsmentioning

confidence: 87%

Antenatal Corticosteroids in the Management of Preterm Birth: Are We Back Where We Started?

Bonanno

Wapner

2012

Obstetrics and Gynecology Clinics of North America

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Section: Efficacy In Special Patient Populationsmentioning

confidence: 87%

Antenatal Corticosteroids in the Management of Preterm Birth: Are We Back Where We Started?

Bonanno

Wapner

2012

Obstetrics and Gynecology Clinics of North America

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“…If these mothers remain undelivered after a week of therapy with steroids, some practitioners use repeated courses in the belief that effect of previous dose has worn off even though there is no scientific basis to support this practice [6,[27][28][29]. Long-term follow up studies of infants born after use of a single course of antenatal steroids have not shown any deleterious effects on survivors [4,5,30,31] but there is substantial body of evidence from animal [32][33][34] and human studies that repeated courses of steroids offer no advantage and may even be harmful for the mother as well as the newborn [10,35,36].…”

Section: Discussionmentioning

confidence: 99%

“…This form of therapy led to improvement in short term [3] and long term outcomes [4,5] of these infants. Later obstetricians all over the world started using multiple courses of steroids when delivery did not occur after the first course of steroids [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Antenatal Dexamethasone Treatment Leads to Changes in Gene Expression in a Murine Late Placenta

Baisden

Sonne

Joshi³

et al. 2007

Placenta

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Antenatal steroids like dexamethasone (DEX) are used to augment foetal lung maturity and there is a major concern that they impair foetal growth. If delivery is delayed after using antenatal DEX, placental function and hence foetal growth may be compromised even further. To investigate the effects of DEX on placental function, we treated 9 pregnant C57/BL6 mice with DEX and 9 pregnant mice were injected with saline to serve as controls. Placental gene expression was studied using microarrays in 3 pairs and other 6 pairs were used to confirm microarray results by semi-quantitative RT-PCR, real-time PCR, in situ hybridization, western blot analysis and Oligo ApopTaq assay. DEXtreated placentas were hydropic, friable, pale, and weighed less (80.0±15.1 mg compared to 85.6.8 ±7.6 mg, p=0.05) (n=62 placentas). Foetal weight was significantly reduced after DEX use (940±32 mg compared to 1162±79 mg, p=0.001) (n=62 foetuses). There was > 99% similarity within and between the three gene chip data sets. DEX led to down-regulation of 1212 genes and up-regulation of 1382 genes. RT-PCR studies showed that DEX caused a decrease in expression of genes involved in cell division such as cyclins A2, B1, D2, cdk 2, cdk 4 and M-phase protein kinase along with growth-promoting genes such as EGF-R, BMP4 and IGFBP3. Oligo ApopTaq assay and western blot studies showed that DEX-treatment increased apoptosis of trophoblast cells. DEX-treatment led to up-regulation of aquaporin 5 and tryptophan hydroxylase genes as confirmed by real-time PCR, and in situ hybridization studies. Thus antenatal DEX treatment led to a reduction in placental and foetal weight, and this effect was associated with a decreased expression of several growth-promoting genes and increased apoptosis of trophoblast cells.

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“…By contrast, in a study on 124 IUGR and preterm infants born at 26-31 weeks' gestation in 1984-1991, Schaap et al [25 ]found a significant protective effect of ACT on neurodevelopmental development, with greater survival without disability or handicap at 2 years of corrected age (OR 3.2 [1.1-11.2]) compared to non-IUGR and preterm infants. Nevertheless, this was a case-control study based on a small number of patients from only 2 centers and all born by C-section.…”

Section: Discussionmentioning

confidence: 95%

Efficacy of Antenatal Corticosteroid Treatment on Neurodevelopmental Outcome according to Head Circumference at Birth

Basset

Nusinovici²,

Huetz

et al. 2017

Neonatology

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Background: There are concerns about the efficacy of antenatal corticosteroid treatment (ACT) in the growth-restricted fetus. Objective: To evaluate the effect of ACT on neurodevelopmental outcome at 2 years of corrected age according to the z score of birth head circumference (ZS HC) in a large prospective cohort of preterm infants. Methods: This study was conducted as a population-based, prospective, multicenter study, including 4,965 infants born between 24 and 33 weeks' gestation and whose status regarding ACT and the measurement of head circumference at birth were available. They were evaluated at 2 years of corrected age to assess neurological outcome. Three approaches were considered to estimate the effect of ACT on neurodevelopment: (i) logistic regression with adjustment on propensity score, (ii) weighted logistic regression using the inverse probability of treatment weighting method, and (iii) 1:1 matching of gestational age, ZS HC, and propensity score between treated and nontreated infants. Results: ACT was documented in 60% of infants. Three groups of infants were considered according to their ZS HC: between -3 and -1 standard deviation (SD), -1 and +1 SD, and +1 and +3 SD, respectively. ACT was associated with a significant improvement of neurodevelopmental outcome only for infants with an ZS HC of between +1 and +3 SD (adjusted OR 1.72; 95% CI 1.06-2.79). Moreover, ORs estimated in the -3 to -1 and +1 to +3 categories were significantly different. Conclusion: We found beneficial effects of ACT on neurodevelopmental outcomes at 2 years of corrected age only in preterm infants with a ZS HC >1 SD.

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Effects of antenatal corticosteroid administration on mortality and long-term morbidity in early preterm, growth-restricted infants

Abstract: Benefits from antenatal corticosteroids for early preterm, growth-restricted infants appear to outweigh possible adverse effects.

Cited by 56 publications

References 29 publications

Antenatal Corticosteroids in the Management of Preterm Birth: Are We Back Where We Started?

Antenatal Corticosteroids in the Management of Preterm Birth: Are We Back Where We Started?

Antenatal Dexamethasone Treatment Leads to Changes in Gene Expression in a Murine Late Placenta

Efficacy of Antenatal Corticosteroid Treatment on Neurodevelopmental Outcome according to Head Circumference at Birth

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