[Use and misuse of steroids to newborn].
BACKGROUND
A growing number of extremely preterm neonates survive; a high percentage develop chronic lung disease/bronchopulmonal dysplasia. The short-term effect of glucocorticoids in prevention or treatment is beneficial, but short- and long-term side effects are of concern.


METHODS
Based on non-systematic searches in the Medline and Cochrane databases, this article provides an overview of beneficial and detrimental effects (emphasis on long-term side effects) of glucocorticoids in the neonatal period.


CONCLUSIONS
Steroids have a beneficial short-term effect on bronchopulmonal dysplasia, with reduced duration of ventilator treatment and decreased needs for oxygen supplementation at 36 weeks gestational age (odds ratio 0.62-0.76). However, survival at 40 weeks is not improved due to severe side effects. Long-term effects on neurodevelopmental outcome show a significant increase in the risk for cerebral palsy (odds ratio 1.69) and a significant increase in the risk for abnormal neurological development and cognitive impairment of equal size. No significant effects on lung function, growth and metabolic outcome later in childhood have been proven so far. Given that glucocorticoids do not increase survival of neonates, their serious side effects indicate that they should only be considered with severe ventilator-dependent lung disease after 2-3 weeks.
Størdal
Ketil
K
Barneavdelingen, Sykehuset Østfold Fredrikstad, 1602 Fredrikstad. ketil.stordal@c2i.net
Lunde
Jon
J
D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy* / Q000517:prevention & control; D002657:Child Development / Q000187:drug effects; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D011379:Prognosis; D012307:Risk Factors
D005938:Glucocorticoids