Two-year follow-up of a randomised trial with repeated antenatal betamethasone

Peltoniemi, Outi; Kari, M. Anneli; Lano, Aulikki; Yliherva, Anneli; Puosi, Riina; Lehtonen, Liisa; Tammela, Outi; Hallman, Mikko

doi:10.1136/adc.2008.150250

Cited by 46 publications

(31 citation statements)

References 26 publications

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“…15 However, the earlier trials with multiple courses of prenatal corticosteroid therapy have now reported 2-year outcomes. [16][17][18] All reported no significant differences in rates of death or major neurodevelopmental difficulties at 2 years of age. One study did note a nonsignificant increase in cerebral palsy in the group exposed to more courses of prenatal corticosteroid therapy, but this was not observed in the other studies.…”

Section: Discussionmentioning

confidence: 96%

Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study: 2-Year Outcomes

et al. 2010

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Section: Discussionmentioning

confidence: 96%

Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study: 2-Year Outcomes

et al. 2010

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“…A magnetic resonance imaging study in human newborns suggested that exposure to repeated courses (Ն2 courses of 24 mg of betamethasone) to mothers at risk of preterm labor was associated with decreased cortical surface complexity (28). The results of postnatal studies of preterm human offspring exposed to repeated courses of antenatal steroids for threatened preterm labor are inconsistent, as a number of studies demonstrated no major untoward effects at 2 years of age (8,29,30), but others demonstrated a higher incidence of cerebral palsy (31), behavioral abnormalities, and/or attention issues (30,32,33).…”

Section: Discussionmentioning

confidence: 99%

Prenatal Anti‐Ro Antibody Exposure, Congenital Complete Atrioventricular Heart Block, and High‐Dose Steroid Therapy: Impact on Neurocognitive Outcome in School‐Age Children

Kelly

Sananes

Chiu‐Man

et al. 2014

Arthritis & Rheumatology

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Objective. To determine the impact of prenatal exposure to maternal anti-Ro antibodies, slow fetal heart rate, and/or prolonged dexamethasone therapy for immune-mediated congenital atrioventricular heart block (CAVB) on the cognitive and academic performance of these children at school age.Methods. We performed a prospective, blinded assessment of the cognitive functioning of 3 cohorts of children ages 6-16 years with in utero exposure to maternal anti-Ro antibodies in the following groups: no CAVB and no prenatal dexamethasone treatment (n ‫؍‬ 14), CAVB without prenatal treatment (n ‫؍‬ 10), and CAVB with prenatal dexamethasone treatment (n ‫؍‬ 16). Domains assessed included intelligence, visual perceptual and visual motor skills, auditory and visual attention, verbal learning and memory, visual memory, executive function, and behavior.Results. All cohorts scored within the normal range and were not significantly different in terms of intelligence scores, verbal comprehension, perceptional reasoning, working memory, and processing speed. For children with CAVB who were treated prenatally, there were no significant associations between the neurocognitive function scores, the minimal fetal heart rate (range 47-80 beats per minute), and either the duration (range 2-15 weeks) or dosage (range 56-824 mg) of dexamethasone therapy.Conclusion. CAVB and transplacental treatment with dexamethasone was not associated with neurocognitive impairment in school-age children. Larger numbers of children are needed to validate our observation, and assessment of other cognitive abilities is warranted.

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“…However, there was an almost significant association between multiple ANS courses and the risk of cerebral palsy (p = 0.06) [27] . The randomized trials studying the effect of a single repeat course of betamethasone showed a decrease in the risk of RDS, without early growth retardation and no evidence on adverse neurological outcome at the corrected age of two years [28,30,31] . The follow-up studies are not complete yet.…”

Section: Therapies Enhancing Maturity Of Fetuses With Threatened Pretmentioning

confidence: 99%

“…Follow-up studies on the efficacy and safety of repeated ANS are available for the two large trials. There were no significant differences in neurological development or growth during the first 2 years of life [27][28][29] . However, there was an almost significant association between multiple ANS courses and the risk of cerebral palsy (p = 0.06) [27] .…”

Section: Therapies Enhancing Maturity Of Fetuses With Threatened Pretmentioning

confidence: 99%

Enhancing Functional Maturity before Preterm Birth

2010

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Enhancing functional maturity of the high-risk preterm fetus is aimed at decreasing the life-threatening neonatal disorders that increase the burden of chronic disease. A course of antenatal glucocorticoids before 35 weeks of pregnancy substitutes endogenous activation of the hypothalamic-adrenal axis that spontaneously enhances functional maturity and augments cytokine-induced preterm lung maturity. It is the main fetal therapy that decreases the functional prematurity-related neonatal morbidity in the era of surfactant therapy. Tocolytic agents potentiate the effect of glucocorticoids on the fetus. Repeating an antenatal glucocorticoid course may be recommended if the preterm fetus remains undelivered for more than 7 days and very preterm birth is imminent. However, the follow-up results are still incomplete, and available preliminary studies warn against adverse neurological and metabolic consequences following several antenatal repeat courses of glucocorticoids. Administration of glucocorticoids after 34 weeks of pregnancy may be considered in selected high-risk cases, preferably with documented lung immaturity. We recommend delaying elective delivery in low-risk pregnancies without established lung maturity until 40 weeks, unless labor starts earlier. In a selected high-risk population 17α-hydroxyprogesterone acetate decreases the prematurity rate. However, this drug has a limited impact on functional maturity of the preterm fetus and its effects on the development of the child remain to be studied further.

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Two-year follow-up of a randomised trial with repeated antenatal betamethasone

Abstract: A single repeat dose of antenatal BM tended not to influence physical growth or neurodevelopment at 2 years of age.

Cited by 46 publications

References 26 publications

Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study: 2-Year Outcomes

Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study: 2-Year Outcomes

Prenatal Anti‐Ro Antibody Exposure, Congenital Complete Atrioventricular Heart Block, and High‐Dose Steroid Therapy: Impact on Neurocognitive Outcome in School‐Age Children

Enhancing Functional Maturity before Preterm Birth

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