Glucocorticoids preterm infants

In children, a leukemoid reaction has been induced by betamethasone treatment (135) this possibility must always be borne in mind, since glucocorticoids can actually be used to treat leukemia or its complications. A case of very high white blood cell count with neutrophilia in a preterm infant whose mother had received two doses of betamethasone prenatally to enhance fetal lung maturation is one of a short list of leukemoid reactions possibly attributable to antenatal glucocorticoid treatment (136). 

In an analysis of 595 preterm infants born at 26-32 weeks gestation during a randomized controlled trial for the prevention of lung disease, glucocorticoids given to women at risk of preterm delivery promoted fetal lung maturation, reduced the incidence of respiratory distress syndrome, and reduced neonatal morbidity and mortality (370). Dexamethasone was given as either two doses of 12 mg 24 hours apart or four doses of 6 mg every 6 hours. Mortality was 9.2% after three or more courses, compared with 4.8% after one or two courses. This association was not explained by other factors (maternal or other common preterm morbidities). 

As far as the child is concerned, there may be only moderate adrenal suppression (392), although in some cases substitution treatment with glucocorticoids can be necessary in such babies short-term treatment with betamethasone shortly before birth generally does not inhibit the infant s adrenal capacity to react to corticotropin (393). A single case of a leukemoid reaction in a preterm infant has been observed, after the mother was given betamethasone shortly before delivery (SEDA-3, 306). 

Thebaud B, Lacaze-Masmonteil T, Watterberg K. Postnatal glucocorticoids in very preterm infants the good, the bad, and the ugly Pediatrics 2001 107(2) 413-5. 

In a double-blind, randomized pilot study of the efficacy and adverse effects of inhaled fluticasone in 25 newborn preterm infants who required mechanical ventilation for treatment of respiratory distress syndrome, the infants were randomized to receive inhaled fluticasone 1000 micrograms/day or placebo (47). The hypothalamic-pituitary-adrenal axis was assessed by the response to corticotropin-releasing factor. AU basal and post-stimulation plasma corticotropin and serum cortisol concentrations were significantly less with inhaled fluticasone than placebo. Cumulative high-dose inhaled glucocorticoids caused moderately severe suppression of both the pituitary and the adrenal glands. This systemic activity is probably associated with pulmonary vascular absorption that avoids hepatic first-pass metabolism. 

In a retrospective study of the benefits and risks of multiple courses of glucocorticoids in patients with preterm premature rupture of membranes, 170 preterm singleton infants were evaluated (381). They were divided into three groups non-use (n — 50), single courses (.n — 76), and multiple courses (n — 44). There was a higher incidence of chorioamnionitis those who had received multiple courses. 

In an Italian prospective study, 201 preterm singleton infants received one or more antenatal courses of a glucocorticoid (398). Neurodevelopment was evaluated at 2 years 138 subjects received at least one complete course of betamethasone (37 multiple) and 63 patients received dexamethasone (33 multiple). The prevalence of infant... 

Administration of antenatal glucocorticoids to women at risk of preterm birth has major benefits for infants but the use of repeated doses is controversial. A Cochrane systematic review of randomised trials, using standard Cochrane methodology, to assess the effechveness and safety of one or more repeated doses given to women at risk of preterm birth 7 or more days after an initial course Ten trials were included involving over 4,730 women and 5,700 infants. Treatment with repeated doses compared with no repeated treatment reduced the risk of respiratory distress syndrome (risk ratio, 0.83 95% Cl, 0.75-0.91) and serious neonatal morbidity (risk ratio, 0.84 95% Cl, 0.75-0.94). At 2- to 3-year follow-up (4 trials, 4,170 children), there was no evidence of either significant benefit or harm. Repeat doses of glucocorticoids should be considered in women at risk of preterm birth 7 or more days after an initial course, in view of the neonatal benefits. 

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