Growth in the neonatal period after repeat courses of antenatal corticosteroids: data from the ACTORDS randomised trial

Battin, Malcolm; Bevan, Coila; Harding, Jane E.

doi:10.1136/adc.2011.211318

Cited by 19 publications

(14 citation statements)

References 43 publications

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“…There was a trend towards an incremental decrease in birth weight, length and head circumference for each additional course of antenatal corticosteroids. According to the results of the ACTORDS (Antenatal Collaborative Trial of Repeat Doses of Prenatal Steroids) trial, infants exposed to weekly doses of repeat antenatal corticosteroids presented postnatal growth acceleration 3–5 weeks after birth, which is similar to the catch-up growth observed in intrauterine growth restricted infants [46 ▪ ]. Compared with a single course of antenatal glucocorticoids, exposure to repeated doses of antenatal betamethasone was not associated with adverse effects on lung function or altered bone mass in early school-age children [47,48].…”

Section: Multiple Steroid Dosesmentioning

confidence: 90%

Antenatal steroids

Romejko-Wolniewicz¹,

Teliga-Czajkowska

Czajkowski³

2014

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewThe beneficial effects of antenatal steroids in women at risk of preterm birth are evident. A dose of 24 mg appears sufficient, but there are insufficient data to recommend betamethasone or dexamethasone, a single steroid dose, the optimal interval between doses and repeated courses, the gestational age at which treatment is beneficial and the long-term effects of steroid treatment. This review addresses these aspects of antenatal steroid treatment.Recent findingsAlthough the 12-h and 24-h dosing intervals are equivalent with respect to prevention of respiratory distress syndrome, the former enables the completion of treatment in 50% more neonates delivered prematurely. Reducing the single steroid dose in patients at risk for premature birth reduces the associated maternal side effects. An inverse relationship has been demonstrated between the number of corticosteroid courses and foetal growth. The reduced size of exposed foetuses has been attributed to birth at earlier gestational ages and decreased foetal growth. Evidence suggests that antenatal exposure to synthetic glucocorticoids in term-born children has long-lasting effects, which may have important implications in the recommendation of steroids before elective caesarean at term.SummaryThe short-term and long-term effects of the dosage regimen on the pregnant mother and foetus remain unclear.

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Section: Multiple Steroid Dosesmentioning

confidence: 90%

Antenatal steroids

Romejko-Wolniewicz¹,

Teliga-Czajkowska

Czajkowski³

2014

Current Opinion in Obstetrics &Amp; Gynecology

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“…Since the trials conducted by Liggins and Howie in 19726), many observational and controlled studies have reported that antenatal administration of glucocorticoids (GCs) to mothers at risk of preterm birth decreases the severity of respiratory distress syndrome and improves the survival of preterm infants6,7,8,9,10). However, repeated courses of antenatal GCs may be associated with reduced fetal brain growth and long-term neurodevelopmental impairment10,11,12,13,14,15,16,17). Several studies of systematic reviews and meta-analyses have shown that postnatal use of GCs to prevent or treat chronic lung disease (CLD) in preterm infants may facilitate extubation and decrease the incidence of bronchopulmonary dysplasia (BPD), but have found that it increases the risk of neurodevelopmental impairment and cerebral palsy (CP), particularly in infants treated with dexamethasone within the first week of life2,3,4,5,18,19,20,21,22,23,24).…”

Section: Introductionmentioning

confidence: 99%

Evidence for adverse effect of perinatal glucocorticoid use on the developing brain

Chang

2014

Korean J Pediatr

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The use of glucocorticoids (GCs) in the perinatal period is suspected of being associated with adverse effects on long-term neurodevelopmental outcomes for preterm infants. Repeated administration of antenatal GCs to mothers at risk of preterm birth may adversely affect fetal growth and head circumference. Fetal exposure to excess GCs during critical periods of brain development may profoundly modify the limbic system (primarily the hippocampus), resulting in long-term effects on cognition, behavior, memory, co-ordination of the autonomic nervous system, and regulation of the endocrine system later in adult life. Postnatal GC treatment for chronic lung disease in premature infants, particularly involving the use of dexamethasone, has been shown to induce neurodevelopmental impairment and increases the risk of cerebral palsy. In contrast to studies involving postnatal dexamethasone, long-term follow-up studies for hydrocortisone therapy have not revealed adverse effects on neurodevelopmental outcomes. In experimental studies on animals, GCs has been shown to impair neurogenesis, and induce neuronal apoptosis in the immature brains of newborn animals. A recent study has demonstrated that dexamethasone-induced hypomyelination may result from the apoptotic degeneration of oligodendrocyte progenitors in the immature brain. Thus, based on clinical and experimental studies, there is enough evidence to advice caution regarding the use of GCs in the perinatal period; and moreover, the potential long-term effects of GCs on brain development need to be determined.

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“…For instance, corticosteroids decrease the longitudinal growth. Previous studies have shown that there is a correlation between the number of doses and amount of steroid given antenatal and during neonatal period [1,2]. After the end of repeated administration of antenatal corticosteroids there was a postnatal growth acceleration, catch up, 3-5 weeks after birth [1].…”

Section: Introductionmentioning

confidence: 91%

“…Previous studies have shown that there is a correlation between the number of doses and amount of steroid given antenatal and during neonatal period [1,2]. After the end of repeated administration of antenatal corticosteroids there was a postnatal growth acceleration, catch up, 3-5 weeks after birth [1]. Keller et al have found that short-term growth of premature infants treated with dexamethasone for BPD, was decreased for up to 72 hours after stopping therapy [2].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Knemometry is a Valuable Method to Estimate Health in Infants

Törnhage¹

2017

Current Trends in Endocrinology

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Preterm and term infants often become sick and need different forms of medical or surgical interventions. During sickness, infants' appetite decreases which results in nutritional problems. The consequences of inadequate nutrition can be changes in growth. The options to measure growth during short periods, from a few days up to one week, in unhealthy preterm infants have been limited to body weight. Weight can be hard to estimate because of intensive care limiting our possibilities to handle the infant. However, increasing weight is not always associated with good growth/health and in contrast it can be associated with decreased kidney function or given pharmacy. Knemometry is a validated and reliable method for measuring the distance from the heel to the upper side of the 90 degree-flexed knee, the kneeheel length (KHL). The daily increase in KHL is about 0.5 mm. The precision of the instrument is 0.05 mm, and therefore daily measurements can be done. The aims of this study were to 1) estimate the KHL in healthy newborns and 2) to compare KHL in unhealthy preterm-term infants up to ten months of life. The study group included about fifty term and preterm healthy (reference group) and sick infants (case group). A validated miniknemometer produced by the Medical Technical Department at Aarhus University, Denmark was used. At each measurement, five estimations were done consecutively, and the mean value and standard deviation (SD) were estimated. The total number of occasions of analysis for each child

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Growth in the neonatal period after repeat courses of antenatal corticosteroids: data from the ACTORDS randomised trial

Abstract: Babies exposed to weekly doses of repeat antenatal corticosteroids demonstrate postnatal growth acceleration 3-5 weeks after birth.

Cited by 19 publications

References 43 publications

Antenatal steroids

Antenatal steroids

Evidence for adverse effect of perinatal glucocorticoid use on the developing brain

Knemometry is a Valuable Method to Estimate Health in Infants

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