Steroid Use in Preterm Infants May Cause Cerebral Palsy
Use of the steroid dexamethasone in preterm infants with respiratory distress syndrome is associated with a significantly increased incidence of cerebral palsy and developmental delay, according to new research.
Researchers compared a three-day course of dexamethasone with a placebo (saline) administered from before 12 hours of age in preterm infants, who were being treated for respiratory distress syndrome (RDS) and had received surfactant treatment.
RDS is a disorder that occurs in premature infants and is characterized by a deficiency of the surfactant coating the inner surface of the lungs, by failure of the lungs to expand and contract properly during breathing, and by the accumulation of a protein-containing film lining the alveoli and their ducts. A sufactant is a surface-active lipoprotein mixture which coats the alveoli of the lungs and prevents the collapse of the lungs.
According to researchers:
"Dexamethasone treatment was associated with an increased incidence of hypertension, hyperglycemia, and gastrointestinal hemorrhage and no reduction in either the incidence or severity of chronic lung disease or mortality."
In addition, there were no differences between the groups in terms of:
Perinatal or neonatal course
Antenatal steroid administration
Severity of initial disease
Dexamethasone treated children had a nearly 5-fold increased incidence of cerebral palsy and nearly a 3-fold increased risk of developmental delay.
Researchers note that eleven children with cerebral palsy had normal ultrasound scans and all 11 had received dexamethasone.
The study's authors conclude that "A three day course of dexamethasone administered shortly after birth in preterm infants with respiratory distress syndrome is associated with a significantly increased incidence of cerebral palsy and developmental delay."
Arch Dis Child Fetal Neonatal Ed November, 2000;83:F177-F181
Dangers of Long-term Steroid Use
Long-term use of even low doses of oral steroids, such as predsisone, is associated with a significantly increased risk of hip fracture and cataracts, according to new research.
It is already known that higher doses of steroids pose risks, but it had been assumed that lower doses might be safe.
Researchers used data on nearly 5,000 patients with rheumatoid arthritis who were taking 5 to 10 mg daily (avg. 6.8 mg) of prednisone.
Long-term use of steroids are commonly employed in the treatment of a number of diseases, such as:
Asthma
Rheumatoid arthritis
One of the researchers, Dr. John B. Wong from Tufts-New England Medical Center in Boston, Massachusetts stated in comments to Reuters Health that he suspects that the same correlation found in this study would hold true for inhaled steroids, such as those commonly used long-term in asthmatics.
Meeting of the American College of Chest Physicians October 2000, San Francisco, California
Most people reading this newsletter recognize that steroids are not generally helpful for the long-term health of individuals. However, of all the problems I have come across from these drugs, this is probably the most disturbing. Cerebral palsy is one heck of a side effect. Developmental delay is also not insignificant. Steroids should clearly be avoided if at all possible during this time frame. If the pediatrician or neonatologist refuses, one might consider a second opinion.
However, being that the steroids are being used to treat RDS, by far the best option would be to reduce the incidence of this condition and thereby reduce the need for a treatment with such potentially devastating effects. One simple and effective method that has been shown to reduce the incidence of RDS in premature infants in the practice of delayed clamping of the umbilical cord at birth (J Perinat Med 1995 23:1-2 139-43).
This benefit is most likely due to a greater red blood cell and increased iron levels, which increases the blood's oxygen carrying capacity. However, doesn't it make sense that a practice that is better for preterms would be better for full-term infants as well? Even though a normal infant may not be at high risk for RDS, wouldn't it still be advantageous for the blood to have a greater oxygen carrying capacity?
Also, remember that even the low dose steroids will increase osteoporosis and cataracts. They will increase the risk of diabetes, weight gain and cause a disturbance in your cholesterol levels.
Related Articles:
Asthma, Steroids, and Growth Inhaled Steroid Use And Bone-Mineral Density In Patients With Asthma
Asthma, Steroids, and Growth
Inhaled Steroid Use And Bone-Mineral Density In Patients With Asthma