Antenatal corticosteroids pose risk of neurodevelopmental impairment in preemies: Study
Caution is required in administering antenatal corticosteroids given the associated neurocognitive and/or psychological harms for children with late-preterm and full-term birth, according to a recent study published in the JAMA Pediatrics.
Animal studies have found that antenatal corticosteroids affect many organs across multiple stages of life. However, the long-term outcomes in human children are not well understood.
A study was conducted to conduct a systematic review and meta-analysis of long-term outcomes associated with preterm exposure to antenatal corticosteroids compared with no exposure in all children as well as children with preterm and full-term birth.
Academic databases were searched for articles published from January 1, 2000, to October 29, 2021, including Ovid MEDLINE, Ovid Embase, PsycInfo, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Web of Science, ClinicalTrials.gov, and Google Scholar. References of articles were also searched for relevant studies.
Randomized clinical trials (RCTs), quasi-RCTs, and cohort studies that assessed long-term neurodevelopmental, psychological, or other outcomes at 1 year or older in those who had preterm exposure to antenatal corticosteroids were included. No language restrictions were set.
Two reviewers independently extracted data using a piloted data extraction form. Data on the study population, pregnancy characteristics, exposure to antenatal corticosteroids, and outcomes were collected. Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines were followed, and random-effects models were used for the meta-analysis. The primary outcome was an author-defined composite of any adverse neurodevelopmental and/or psychological disorder. The secondary outcomes included specific measures of psychological disorders; neurodevelopmental delay; and anthropometric, metabolic, and cardiorespiratory outcomes.
The results of this study are:
- A total of 30 studies met the inclusion criteria and involved more than 1.25 million children who were at least 1 year of age when the outcomes were assessed.
- Exposure to a single course of antenatal corticosteroids for children with extremely preterm birth was associated with a significant reduction in the risk of neurodevelopmental impairment.
- For children with late-preterm birth, exposure to antenatal corticosteroids was associated with a higher risk of investigation for neurocognitive disorders
- For children with full-term birth, exposure to antenatal corticosteroids was associated with a higher risk of mental or behavioural disorders as well as proven or suspected neurocognitive disorders.
Thus, the results of this study showed that exposure to a single course of antenatal corticosteroids was associated with a significantly lower risk of neurodevelopmental impairment in children with extremely preterm birth but a significantly higher risk of adverse neurocognitive and/or psychological outcomes in children with late-preterm and full-term birth, who made up approximately half of those with exposure to antenatal corticosteroids. The findings suggest a need for caution in administering antenatal corticosteroids.
Reference:
Evaluation of Long-term Outcomes Associated With Preterm Exposure to Antenatal Corticosteroids: A Systematic Review and Meta-analysis by Kiran Ninan, et. al published in the JAMA Pediatrics.
doi:10.1001/jamapediatrics.2022.0483
Keywords:
Evaluation, Long-term Outcomes, Association, Preterm Exposure, Antenatal, Corticosteroids, Kiran Ninan, Sugee K. Liyanage,Kellie E. Murphy, V. Asztalos, Sarah D. McDonald, JAMA Pediatrics
