Long-term cognitive benefits of antenatal corticosteroids for prematurely born children with cranial ultrasound abnormalities.
OBJECTIVE
Previous studies have examined possible long-term effects of antenatal corticosteroids, but not by the presence of neonatal brain lesions. This study of long-term neurodevelopmental outcomes of antenatal corticosteroid exposure among preterm, very-low-birth-weight infants investigated whether the effects are differential by the presence of neonatal brain injury.


METHODS
Prospective cohort study of cognition, behavior, and cerebral palsy in 251 children (ages 6-8 years) born at < or = 32 weeks of gestation. This sample included 91 children with abnormal neonatal cranial ultrasound findings and 106 children who had been exposed to antenatal corticosteroids.


RESULTS
In children with abnormal cranial ultrasound findings, a complete course of antenatal corticosteroids was associated with an 8.7-point advantage in IQ (95% CI, 1.8, 15.6; P = .016), controlling for confounding factors. Both verbal and nonverbal cognitive scores were increased in a dose-response manner. The advantage was greater for infants born at < or = 28 weeks of gestation and in those with ventriculomegaly. In children with normal cranial ultrasound scans, cognitive function was not related to antenatal corticosteroid exposure. No statistically significant associations were observed between antenatal corticosteroid exposure and either childhood behavioral scores or cerebral palsy.


CONCLUSIONS
Antenatal corticosteroids appear to confer substantial long-term benefits on cognition of very-low-birth-weight infants with cranial ultrasound abnormalities.
Arad
Ilan
I
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Durkin
Maureen S
MS
Hinton
Veronica J
VJ
Kuhn
Louise
L
Chiriboga
Claudia
C
Kuban
Karl
K
Bellinger
David
D
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001519:Behavior; D001921:Brain / Q000002:abnormalities; D002547:Cerebral Palsy / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002648:Child; D003071:Cognition / Q000187:drug effects*; D015331:Cohort Studies; D004453:Echoencephalography; D005260:Female; D005315:Fetal Diseases / Q000503:physiopathology; D005322:Premature Rupture of Fetal Membranes / Q000503:physiopathology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007361:Intelligence Tests; D011247:Pregnancy; D011446:Prospective Studies; D012044:Regression Analysis; D014657:Vasculitis / Q000503:physiopathology
D000305:Adrenal Cortex Hormones