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Antenatal steroids and the developing brain
Andrew Whitelawa, Marianne Thoresenb
a Division of Child
Health, University of Bristol Medical School, Southmead Hospital,
Bristol BS10 5NB, UK, b Division of Child Health, St Michael's
Hospital, Bristol BS2 8EG, UK
Correspondence to: Professor Whitelaw email: andrew.whitelaw{at}bristol.ac.uk
Accepted 5 June 2000
Randomised clinical trials show that two injections of
corticosteroid into the mother before preterm delivery reduce
respiratory distress syndrome, neonatal mortality, and intraventricular
haemorrhage. However, repeated courses of antenatal steroid are not
backed by such evidence of safety and efficacy. Animal studies have
shown that maternal corticosteroid delays myelination and reduces the growth of all fetal brain areas particularly the hippocampus. Corticosteroids may reduce or enhance hypoxic-ischaemic injury to the
developing brain depending on timing and dosage. Clinical trials of
maternally administered corticosteroid show no evidence of increased
disability on follow up but numbers are small. Postnatal trials of
dexamethasone when brain maturity is still preterm show a significant
increase in later disability in the dexamethasone treated groups.
There is evidence from randomised trials, retrospective data,
experiments on pregnant mice, and the chemical make up of the
preparations that betamethasone may be safer and more protective of the
immature brain than dexamethasone. Single course corticosteroid treatment before preterm delivery must still be recommended as a life
saving and cost effective intervention, but clinicians may wish to
change from using dexamethasone to betamethasone. In view of the animal
and postnatal data, clinicians should be cautious with repeated courses
of antenatal corticosteroids and repetition may be unnecessary for lung maturity.
© 2000 by Archives of Disease in Childhood
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- Single versus multiple courses of antenatal steroids - uncertainty remains
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