Postnatal corticosteroids and sensorineural outcome at 5 years of age.
BACKGROUND
Postnatal corticosteroids reduce ventilator dependence in preterm infants, but possible long-term benefits for either survival or sensorineural morbidity are not proved.


OBJECTIVE
The aim of this study was to determine the association between corticosteroid therapy given postnatally and sensorineural outcome in childhood.


METHODS
The subjects comprised 346 consecutive livebirths either of birthweight < 1000 g or with gestational age < 28 weeks born in the state of Victoria during 1991 and 1992, and who survived the first week after birth; 120 (34.7%) were given corticosteroids postnatally.


RESULTS
Of the 120 children who received corticosteroids, 98 (81.7%) survived to 5 years of age, compared with 200 (88.5%) of the 226 children who did not receive corticosteroids. At 5 years of age, survivors treated with corticosteroids postnatally had significantly higher rates of cerebral palsy (corticosteroids 23%, no corticosteroids 4%), blindness (corticosteroids 4%, no corticosteroids 1%) or an intelligence quotient more than one standard deviation below the mean (corticosteroids 54%, no corticosteroids 32%) compared with children not treated with corticosteroids. The rate of sensorineural disabilities imposed by these impairments was significantly higher in children treated with postnatal corticosteroids, and the association between adverse sensorineural outcome and postnatal corticosteroids remained after adjustments for potentially confounding variables. In a separate case-control analysis of 60 children in each group, the rate of cerebral palsy remained significantly elevated (corticosteroids 22%, no corticosteroids 5%).


CONCLUSIONS
Postnatal corticosteroid therapy is associated with substantial adverse sensorineural outcomes at 5 years of age.
The Royal Women's Hospital, the Mercy Hospital for Women, Monash Medical Centre, the Royal Children's Hospital, the Newborn Emergency Transport Service, and the Victorian Perinatal Data Collection Unit, Melbourne, Australia.
D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000139:chemically induced* / Q000453:epidemiology; D002657:Child Development / Q000187:drug effects*; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006319:Hearing Loss, Sensorineural / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D012016:Reference Values; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate
D000305:Adrenal Cortex Hormones