Lung Diseases: Problems of Steroid Treatment of Fetus and Newborn

Abstract

Corticosteroids given in the perinatal period have a multitude of biologic effects on the developing lung. Clearly, some of these will be beneficial to the immature fetus or neonate, while others will be detrimental. For the fetus at risk of preterm birth, a single course of betamethasone or dexamethasone leads to lung maturity and reduces the risk of RDS and other important complications of prematurity. Consensus seems to support repeat courses of prenatal steroids when there is a high risk of preterm birth before 29 weeks’ gestation even if there are some controversies. The beneficial pulmonary effects of early postnatal dexamethasone, in the first week of life, do not seem to outweigh the adverse effects on neurodevelopment. However, late postnatal steroid therapy, after the first week of life, seems to be associated with similar beneficial pulmonary effects without significant increase in neurodevelopmental sequelae. Late steroid therapy with dexamethasone is probably still indicated for preterm infants with CLD who cannot be weaned from ventilation. Thus, administration of corticosteroids in the perinatal period must be based upon clinical judgment of the balance of benefits and risks. Further evaluation should be done considering long-term follow-up in order to confirm their safety before they can be recommended for routine use.