New research in JAMA Pediatrics has found that premature babies do benefit from steroid treatment before birth, even if the full 48-hour course isn’t completed before delivery. This suggests starting steroid treatment promptly – even if the course is unlikely to be completed – is beneficial when extremely premature birth is imminent.
Research released today in the Journal of the American Medical Association has found that even partial steroid treatment before birth can help extremely premature babies (babies born before 22-27 weeks) survive and reduce the risk of certain birth defects.
Research has long stated that steroid therapy is the standard of care for babies born before 34 weeks’ gestation, but researchers were unsure of the effectiveness of the therapy in extremely premature babies. Because full treatment takes 48 hours, physicians sometimes don’t provide mothers with steroid treatment if they are at imminent risk of preterm labor. However, a recent NIH-funded study finds that “starting steroid treatment promptly — even if the likelihood of completion is low — is beneficial when extremely premature birth is imminent.”
The research followed more than 6,100 babies born between gestational weeks 22 and 27 for 18-22 months after birth, and found significant differences between different groups of infants:
- Infants who had the full 48-hour treatment had the lowest rates of death and complications such as brain bleeds (severe intracranial hemorrhages), intestinal issues (necrotizing enterocolitis), lung disease (bronchopulmonary dysplasia) and brain/nervous system impairment.
- Infants who had a partial treatment did significantly better than infants that did not receive steroid treatment at all.
- Infants who received no steroid treatment had the highest rate of the above outcomes.
The researchers found that the better outcomes in treated infants were due to (1) a lower incidence of brain bleeds and (2) lower rates of cystic periventricular leukomalacia (PVL).
Study funding provided by:
- NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
- NIH’s National Center for Advancing Translational Sciences
- Chawla S, Natarajan G, Shankaran S, Pappas A, Stoll BJ, Carlo WA, Saha S, Das A, Laptook AR, and Higgins RD. Association of neurodevelopmental outcomes and neonatal morbidities of extremely premature infants with differential exposure to antenatal steroids. JAMA Pediatrics DOI: 10.1001/jamapediatrics.2016.1936 (2016).