Meta-Analysis: Does Antenatal Corticosteroid Exposure Have Differing Long-Term Neurodevelopmental Effects Based on Timing of Delivery?
BACKGROUND AND PURPOSE:
Ninan et al. (JAMA Pediatrics, 2022) examined long-term outcomes associated with preterm exposure to antenatal corticosteroids vs no exposure based on timing of delivery
Systematic review and meta-analysis (2000 to 2021)
RCTs, quasi-RCTs, cohort studies
Studies that assessed long-term (≥1 year) neurodevelopmental, psychological, or other outcomes associated with exposure to antenatal corticosteroids
Random-effects models were used for the meta-analysis
Proportion of children who were born full term with preterm exposure to antenatal corticosteroids was also calculated
Author-defined composite of any adverse neurodevelopmental and/or psychological disorder
Specific measures of psychological disorders
Anthropometric, metabolic, and cardiorespiratory outcomes
30 studies | 1.25 million children with ≥1 year follow-up
For children with extremely preterm birth, exposure to a single course of antenatal corticosteroids was associated with a significant reduction in risk for
Neurodevelopmental impairment including
Adjusted odds ratio (aOR) 0.69 (95% CI, 0.57 to 0.84); Low certainty
aOR, 0.60 (95% CI, 0.43-0.83); Low certainty
For children with late-preterm birth, exposure to antenatal corticosteroids was associated with a higher risk of investigation for neurocognitive disorders
Adjusted hazard ratio (aHR) 1.12 (95% CI, 1.05 to 1.20); Low certainty
For children with full-term birth, exposure to antenatal corticosteroids was associated with a higher risk for
Mental or behavioral disorders
aHR 1.47 (95% CI, 1.36 to 1.60); Low certainty
Proven or suspected neurocognitive disorders
aHR 1.16 (95% CI, 1.10 to 1.21); Low certainty
Exposure to a single course of antenatal corticosteroids was associated with a significantly lower risk for neurodevelopmental impairments in children with extremely preterm birth
However, for children with late-preterm or full-term birth, there was a higher risk of adverse neurocognitive and/or psychological outcomes with exposure
Limitations of the study include limited RCT data and possible bias associated with observational studies
The authors state
Given that approximately 50% of children who had preterm exposure to antenatal corticosteroids exceeded expectations and were born full term, the timing and dose of antenatal corticosteroid administration should be carefully considered
An accompanying editorial states
…Ninan et al present a systematic review and meta-analysis that shifted the discussion of antenatal corticosteroid administration from the timing of receipt to the timing of delivery
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