October 5, 2007

Corticosteroids’ impact on infants examined

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Steven Gabbe, M.D.

Corticosteroids’ impact on infants examined

Vanderbilt University School of Medicine Dean Steven Gabbe, M.D., co-authored a study published recently in the New England Journal of Medicine that examined whether giving repeated doses of corticosteroids to pregnant women had any deleterious effects on their preterm infants.

Long prescribed by obstetricians, corticosteroids reduce the risk of death and respiratory distress syndrome, as well as the risk of some of the most devastating complications for premature infants.

However, corticosteroids tend to stay in a fetus' system for about one week, so if the baby is delivered after that time frame, the benefit is lost.

“The question remained — do you need to keep treating the mother with repeated doses of corticosteroids to ensure she is treated within that one-week period?” Gabbe said.

The Maternal-Fetal Medicine Units (MFMU) Network of the National Institute of Child Health and Development (NICHD), which Gabbe chaired for a number of years, conducted a randomized clinical trial to study the effects of repeat courses of antenatal corticosteroids on patterns of early childhood growth and development.

The researchers followed about 600 infants who were divided into a placebo group and a repeat corticosteroid group.

“They found, fortunately, that there were no differences in the children's neurologic development, size or weight,” Gabbe said.

There was one difference between the two groups, however. There were more cases of cerebral palsy in the repeat corticosteroid group. Nine of the 161 children, or 5.6 percent, in the repeat steroid group had cerebral palsy compared with two of the 143 children, or 1.4 percent, in the placebo group had it. While this is not considered statistically significant, it does warrant a closer look, Gabbe said.

“This is going to need to be followed further, and data is needed from other studies to confirm that cerebral palsy is not a risk,” Gabbe said.

A similar study conducted in Australia, which used lower doses of corticosteroids than the NICHD study, found that there was no difference in the number of children with cerebral palsy. Dosage seems to be the key.

“The data from our study indicates that there is no evidence of long-term benefit of giving repeated doses, and perhaps some harm in the form of cerebral palsy,” Gabbe said. “The data argue against the weekly administration of antenatal steroids after a single course in women who are at risk. It is important to stop practices that are not beneficial.”