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We read with interest the excellent review by Dr Ng on the fetal and neonatal hypothalamic-pituitary-adrenal axis.(1) Although the issue of antenatal administration of steroids is addressed in a separate section of the paper it is practically restricted to their antenatal use for the prevention of respiratory distress syndrome and other complications of prematurity.
We would agree that this is the commonest...
We would agree that this is the commonest reason for giving steroids antenatally. However albeit rare there are other indications for their administration during pregnancy for purely maternal reasons. An example is the mother who has undergone renal transplantation, where steroids may be given for prolonged periods.
Some 20 years ago we reported 5 babies (2),whose mothers being recipients of of renal transplants had received 10 mg/day of prednisone throughout pregnancy. Umbilical cord plasma cortisol levels ranged from 12.8 microgram/dl to 16.3 microgram/dl. Synachthen test yielded normal adrenal response in all but one where there was no rise of cortisol level at 30 and 60 minutes. This baby received a 10 day ACTH course following which a new Synachthen test yielded a normal resonse. We mention this experience to draw attention to other situations where adminstration of steroids may be rquired during pregnancy. We think that Dr Ng should have addressed these issues too.
1. Ng PC. The fetal and neonatal hypothalamic-pituitary-adrenal axis. Arch Dis Child Fetal Neonatal Ed 2000;82:F250-F254
2. Dellagrammaticas HD, Parkin JM. Maternal renal Transplantation-complications in the newborn baby. Paediatriki 1980;43:364-373
Dr HD Dellagrammaticas MD, FRCPCH
Dr Nicoletta Iacovidou MD
NICU, 2nd Department of PaediatricsUniversity of AthensAglaia Kyriakou Children's HospitalAthens, Greece