Postnatal corticosteroids and developmental outcomes in extremely preterm or extremely low birth weight infants: The Victorian Infant Collaborative Study 2016–17 cohort

Abstract

Aim: Systemic postnatal corticosteroids are used to treat or prevent bronchopulmonary dysplasia (BPD) in extremely preterm (EP) or extremely low birth weight (ELBW) infants but are associated with long-term harm. We aimed to assess the relationship between cumulative postnatal corticosteroid dose and neurodevelopmental outcomes. Methods: Longitudinal cohort study of all EP/ELBW livebirths in Victoria, Australia 2016-2017. Perinatal data were collected prospectively. Neurodevelopmental assessment was performed at 2 years' corrected age. Linear and logistic regression were used to determine relationships between cumulative corticosteroid dose and neurodevelopment, adjusted for gestational age, birth weight, sex and major intraventricular haemorrhage.Results: Seventy-six EP/ELBW infants received postnatal corticosteroids to treat or prevent BPD, 62/65 survivors were seen at 2 years. Median (IQR) cumulative postnatal corticosteroid dose was 1.36 (0.92-3.45) mg/kg dexamethasone equivalent.Higher cumulative corticosteroid dose was associated with increased odds of cerebral palsy, adjusted OR (95% CI) 1.47 (1.04, 2.07). Higher cumulative corticosteroid dose was also associated with lower cognitive and motor developmental scores, however, this weakened after adjustment for confounding variables: cognitive composite score adjusted coefficient (95% CI) −1.3 (−2.7, 0.1) and motor composite score adjusted coefficient (95% CI) −1.3 (−2.8, 0.2). Conclusion: Higher cumulative postnatal corticosteroid dose in EP/ELBW infants is associated with increased odds of cerebral palsy at 2 years' corrected age. Adequately | 1227 DOUGLAS et al.

Postnatal corticosteroid exposure in very preterm infants: A French cohort study

“…In our study, the treatment durations for hydrocortisone and betamethasone were lower, compared to other works ( Nuytten et al, 2017 ). Again, it is not possible to compare our data with previous studies with regard to cumulative doses, since we expressed the cumulative dose of systemic PC as the equivalent dose of hydrocortisone, and this information is not available from previous reports ( Puia-Dumitrescu et al, 2022 ; Douglas et al, 2023 ).…”

Cerebral palsy and postnatal steroids

“…When looking at data from Douglas et al, 1 the mean gestational age (GA) of the PNS group was 24.9 weeks as compared to 26.7 weeks of the no PNS group, which is clinically significant. An infant born at 24 weeks gestation is not the same as an infant born at 26 weeks of GA. With the survival of premature infants at the limit of viability, using PNS is inevitable.…”

“…I read with great interest the accepted version of the article by Douglas et al 1 They described higher odds of cerebral palsy (CP) with the use of higher cumulative doses of postnatal steroids (PNS) but little evidence of any major developmental delay and major disability at 2 years among the same group. CP is associated with many antepartum and intrapartum factors, including maternal tobacco use, illicit drug use, number of pregnancies, miscarriages, diabetes, preeclampsia, clinical chorioamnionitis, prolonged rupture of membranes, male sex, 5‐min Apgar score, infant weight and gestational age 2 .…”

Cerebral palsy and postnatal steroids—Reply

“…We thank Manzar for their letter 1 in response to our study exploring the relationship between cumulative postnatal corticosteroid dose and neurodevelopmental outcomes in extremely preterm (EP) and extremely low birth weight (ELBW) infants. 2 Postnatal corticosteroids are an important therapy for the treatment or prevention of bronchopulmonary dysplasia in extremely preterm infants. 3 As Manzar notes, the mean gestational age was lower for infants in the postnatal corticosteroid group (mean 24.9 vs 26.7 weeks gestation).…”

“…We do not suggest that postnatal steroids to treat or prevent bronchopulmonary dysplasia in EP/ELBW infants should be ‘abandoned’. On the contrary, we have published a systematic review that postnatal corticosteroids started beyond 7 days after birth reduce mortality and bronchopulmonary dysplasia, without evidence of increased risk of cerebral palsy 2 . Nonetheless, more data are needed to determine whether higher cumulative postnatal corticosteroid dose negatively affects long‐term outcomes for EP/ELBW infants.…”