Abstract Objective To explore the effects of antenatal corticosteroids (ACS) on the outcomes of very premature infants (VPIs) and neurodevelopment during infancy. Methods A retrospective study was conducted on 190 VPIs admitted to the Department of Pediatrics of the First Affiliated Hospital of Anhui Medical University from January 2020 to December 2022. The infants were categorized into four groups based on ACS usage and dosage: no ACS group (n=18), single-course group (n=88), multi-course group (n=40), and partial-course group (n=44). The clinical outcomes, Neonatal Behavioral and Neurological Assessment (NBNA) scores at 40 weeks of corrected age, and Gesell Developmental Schedule (Gesell) scores at 1 year of corrected age were compared among the four groups. The impact of timing of ACS use on the Gesell scores of infants at 1 year of corrected age in VPIs with specific gestational ages was analyzed. Results The incidence rates of neonatal respiratory distress syndrome, bronchopulmonary dysplasia, transient tachypnea of the newborn, and neonatal pneumonia were significantly lower in the partial-course, single-course, and multiple-course groups compared with the no ACS group (P<0.008). However, there was no significant difference among the partial-course, single-course, and multiple-course groups (P>0.008). The NBNA scores (behavioral ability, active muscle tone, primitive reflexes, and general assessment) at 40 weeks of corrected age were significantly higher in the no ACS, partial-course, and single-course groups than in the multiple-course group (P<0.008). The proportion of VPIs with normal neurodevelopment at 1 year of corrected age was significantly higher in the no ACS, partial-course, and single-course groups than in the multiple-course group (P<0.008). The timing of ACS use had no significant effect on neurodevelopment at a corrected age of 1 year in infants with various gestational ages (P>0.05). Conclusions ACS is crucial for the development of the respiratory system in VPIs, but multiple courses of ACS may cause neurodevelopmental abnormalities. The impact of ACS use on neurodevelopment is independent of gestational age and the timing of ACS use.
CHEN Zhi,LI Ming,ZHANG Li-Li et al. Effects of antenatal corticosteroids on outcomes of very premature infants and neurodevelopment during infancy[J]. CJCP, 2024, 26(10): 1040-1045.
CHEN Zhi,LI Ming,ZHANG Li-Li et al. Effects of antenatal corticosteroids on outcomes of very premature infants and neurodevelopment during infancy[J]. CJCP, 2024, 26(10): 1040-1045.
Dagklis T, Sen C, Tsakiridis I, et al. The use of antenatal corticosteroids for fetal maturation: clinical practice guideline by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine foundation[J]. J Perinat Med, 2022, 50(4): 375-385. PMID: 35285217. DOI: 10.1515/jpm-2022-0066.
Zhou C, Ye F, Wu H, et al. Recent advances in the study of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) inhibitors[J]. Environ Toxicol Pharmacol, 2017, 52: 47-53. PMID: 28366868. DOI: 10.1016/j.etap.2017.02.021.
van der Merwe JL, Sacco A, Toelen J, et al. Long-term neuropathological and/or neurobehavioral effects of antenatal corticosteroid therapy in animal models: a systematic review[J]. Pediatr Res, 2020, 87(7): 1157-1170. PMID: 31822018. DOI: 10.1038/s41390-019-0712-1.
Norberg H, St?lnacke J, Diaz Heijtz R, et al. Antenatal corticosteroids for preterm birth: dose-dependent reduction in birthweight, length and head circumference[J]. Acta Paediatr, 2011, 100(3): 364-369. PMID: 21054513. DOI: 10.1111/j.1651-2227.2010.02074.x.
Li J, Wang ZN, Chen YP, et al. Late gestational maternal serum cortisol is inversely associated with fetal brain growth[J]. Neurosci Biobehav Rev, 2012, 36(3): 1085-1092. PMID: 22206902. DOI: 10.1016/j.neubiorev.2011.12.006.
Navalón P, Campos-Berga L, Buesa J, et al. Rescue doses of antenatal corticosteroids, children's neurodevelopment, and salivary cortisol after a threatened preterm labor: a 30-month follow-up study[J]. Am J Obstet Gynecol MFM, 2023, 5(7): 100918. PMID: 36882125. DOI: 10.1016/j.ajogmf.2023.100918.
Gentle SJ, Carlo WA, Tan S, et al. Association of antenatal corticosteroids and magnesium sulfate therapy with neurodevelopmental outcome in extremely preterm children[J]. Obstet Gynecol, 2020, 135(6): 1377-1386. PMID: 32459430. PMCID: PMC7278037. DOI: 10.1097/AOG.0000000000003882.
Sarid EB, Stoopler ML, Morency AM, et al. Neurological implications of antenatal corticosteroids on late preterm and term infants: a scoping review[J]. Pediatr Res, 2022, 92(5): 1225-1239. PMID: 35681094. DOI: 10.1038/s41390-022-02135-3.
