Document Detail


Current controversies surrounding the use of repeated courses of antenatal steroids.
MedLine Citation:
PMID:  12881942     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The use of a single dose of antenatal steroids to facilitate fetal lung maturation in the expectant management of threatened preterm birth has significantly improved the mortality and morbidity of premature infants worldwide. In some settings, the evidence for this practice has been extrapolated with self-reports of up to 6 repeated courses during the antepartum period. Concerns about the use of repeated antenatal courses prompted the National Institutes of Health (NIH) to publish a consensus statement (2000) that reaffirmed the safety and efficacy of a single course of antenatal steroids, but emphasized that there are no data to support the safety and efficacy of repeated courses. The statement cautions against the use of multiple courses outside of research protocols. Despite these recommendations, wide variations in clinical practice continue to exist. There are growing concerns about the potential deleterious effects of steroid exposure on the developing human brain. It is plausible, although not proven, that negative neurodevelopmental impact may occur, or be compounded by multiple antenatal or combined antenatal and postnatal steroid exposures. This article provides a review of the evidence to support appropriate steroid use. The physiology and pharmacology of both endogenous and exogenous steroids are outlined to enhance the clinician's understanding of these potent agents. Recommendations for targeted clinical evaluation and short- and long-term follow-up of steroid exposed infants are provided. A clear understanding of the known and potential risks and benefits of single and multiple courses of antenatal steroids is essential to prompt a critical re-examination of the safety and efficacy of repeated steroid exposure in the neonate.
Authors:
Philippe Lamer
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Advances in neonatal care : official journal of the National Association of Neonatal Nurses     Volume:  2     ISSN:  1536-0903     ISO Abbreviation:  Adv Neonatal Care     Publication Date:  2002 Dec 
Date Detail:
Created Date:  2003-07-28     Completed Date:  2003-08-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  101125644     Medline TA:  Adv Neonatal Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  290-300; quiz 301-3     Citation Subset:  IM    
Affiliation:
Department of Nursing, McGill University Health Center, Montreal Children's Hospital, 2300 Tupper St (C-920), Montreal, Quebec, H3H 1P3, Canada. philippe.lamer@muhc.mcgill.ca
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MeSH Terms
Descriptor/Qualifier:
Brain / drug effects*,  embryology
Clinical Competence / standards*
Embryonic and Fetal Development / drug effects
Female
Fetal Organ Maturity / drug effects*
Glucocorticoids / administration & dosage*,  adverse effects*
Humans
Infant, Newborn
Lung / embryology
National Institutes of Health (U.S.) / standards
Pregnancy
Prospective Studies
Randomized Controlled Trials as Topic
Respiratory Distress Syndrome, Newborn / prevention & control*
Risk Factors
United States
Chemical
Reg. No./Substance:
0/Glucocorticoids

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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