Steroid therapy in the perinatal period

Antenatal steroids prior to preterm delivery reduce mortality and the serious complications of prematurity, but steroid treatment after birth appears to have different effects. Randomized-controlled trials of early postnatal steroid administration have shown a reduction in lung disease, but at the expense of an increased risk of cerebral palsy. It is also possible that steroid therapy may have detrimental effects on alveolar development. Postnatal dexamethasone for the treatment of chronic lung disease was widely used in the 1990s following a study demonstrating a reduced duration of ventilation (but not hospital stay), and for historical reasons large doses of dex-amethasone were given. This practice has largely been abandoned since the publication of data linking postnatal dexamethasone to cereberal palsy in preterm infants. Treatment with more physiological doses of hydrocortisone are currently being investigated in the context of clinical trials.

Figure 12.1 Flow chart: Adrenal failure

■ Adrenal suppression following g postnatal steroids 1.

Both systemic and inhaled steroids are associated with adrenal suppres- d sion in neonates, the severity and duration related to the duration of n steroid treatment. Following a 7-day course of dexamethasone basal and n

ACTH-stimulated Cortisol levels are suppressed at 24 h, but not at 48 h or 10 f days. Following a 3-week course data vary, but 1-7 days post-treatment low e baseline and reduced response to ACTH have been reported, which are no y longer evident at 28 days. A low threshold for steroid cover (2-3 X replacement dose) should be used in infants becoming unwell shortly after stopping a steroid course of > 10 days duration.

■ INHERITED CONDITIONS ASSOCIATED WITH CONGENITAL ADRENAL INSUFFICIENCY

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