From the Guidelines
Corticosteroids should be used with caution in premature babies, as the benefits of improved respiratory status and faster weaning from the ventilator must be weighed against the potential risks of hyperglycemia, hypertension, gastrointestinal bleeding, and adverse neurologic outcomes, as noted in studies such as 1.
Key Considerations
- The use of corticosteroids in premature babies is a complex issue, with both benefits and risks that must be carefully considered, as discussed in 1 and 1.
- The most recent and highest quality study, 1, suggests that early hydrocortisone treatment may reduce the incidence of bronchopulmonary dysplasia (BPD) in preterm infants, but the evidence is not yet conclusive.
- Inhaled steroids, such as beclomethasone, may be a viable alternative to systemic corticosteroids, as they have been shown to improve lung function and reduce the need for mechanical ventilation, as noted in 1.
Recommendations
- Corticosteroids should only be used in premature babies when the benefits outweigh the risks, and under close monitoring for potential side effects, as recommended in 1.
- The decision to use corticosteroids in premature babies should be made on a case-by-case basis, taking into account the individual baby's medical condition and the potential risks and benefits of treatment, as discussed in 1 and 1.
- Further research is needed to fully understand the effects of corticosteroids on premature babies and to determine the optimal treatment strategies, as noted in 1.
From the FDA Drug Label
Neonatal hypoglycemia has been reported after antenatal administration, especially in preterm, low birth weight infants, and when betamethasone is administered close to the time of delivery The use of corticosteroids like betamethasone in premature babies may be associated with neonatal hypoglycemia, particularly in preterm and low birth weight infants.
- Key considerations:
- Administration close to delivery may increase the risk of neonatal hypoglycemia
- Monitoring of blood sugar levels is essential in premature babies whose mothers have received corticosteroids 2
From the Research
Premature Baby Corticosteroids
- The administration of antenatal corticosteroids in cases of imminent preterm delivery can enhance fetal lung maturation and reduce the incidence of respiratory distress syndrome, leading to improved neonatal outcomes 3.
- A single course of antenatal corticosteroids from 24 up to 34 gestational weeks should be offered, with betamethasone and dexamethasone being the most widely used drugs, having similar effectiveness and a recommended dosage of 24mg in divided doses, over a 24-hour period 3.
- Antenatal corticosteroids reduce the risk of perinatal death, neonatal death, and respiratory distress syndrome, and probably reduce the risk of intraventricular haemorrhage (IVH) and have little to no effect on birthweight 4.
Types of Corticosteroids
- Dexamethasone may have some benefits compared with betamethasone, such as less IVH, and a shorter length of stay in the NICU 5.
- The intramuscular route may have advantages over the oral route for dexamethasone, as identified in one small trial 5.
- It remains unclear whether one corticosteroid (or one particular regimen) has advantages over another, with most trials comparing dexamethasone versus betamethasone 6.
Administration Regimens
- The standard regimen of antenatal corticosteroids involves a single course of 2 × 12 mg betamethasone administered intramuscularly within 24 h 7.
- The administration of corticosteroids usually is performed between 24 and 34 weeks gestation, but may be beneficial even at 23 weeks and at 35-36 weeks of gestation under particular circumstances 7.
- The evidence to date is clearly against the routine administration of multiple antenatal steroid courses, although a second course of betamethasone ("rescue course") may be justifiable in special clinical situations 7.