Current evidence for prenatal and postnatal corticosteroids in preterm infants

Arch Dis Child Fetal Neonatal Ed. 2022 Mar;107(2):121-125. doi: 10.1136/archdischild-2020-319706. Epub 2021 Mar 3.

Abstract

Antenatal corticosteroids undoubtedly save many lives and improve the quality of many others. However, the currently accepted dosage schedule has been in place since 1972, and recent studies have suggested that beneficial effects may be seen with less. Most but not all studies of long-term outcome show no adverse effects. The use of antenatal corticosteroids in women with COVID-19 raises important questions regarding potential risks and benefits. However, currently, most authorities recommend continuing according to published guidelines. With regard to postnatal corticosteroids, alternatives to systemic dexamethasone, the somewhat tainted standard of care, show promise in preventing bronchopulmonary dysplasia without adverse effects. Systemic hydrocortisone and inhaled corticosteroids are of note. The mixture of surfactant and corticosteroids deserves particular attention in the coming years.

Keywords: neonatology; pharmacology.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / adverse effects
  • Adrenal Cortex Hormones / therapeutic use*
  • Bronchopulmonary Dysplasia / drug therapy
  • COVID-19 / epidemiology*
  • COVID-19 Drug Treatment
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Pregnancy
  • Pregnancy Complications, Infectious / drug therapy
  • Premature Birth / prevention & control
  • Prenatal Exposure Delayed Effects / epidemiology*
  • Pulmonary Surfactants / therapeutic use
  • SARS-CoV-2

Substances

  • Adrenal Cortex Hormones
  • Pulmonary Surfactants