WEDNESDAY. Sept. 19 (HealthDay News) -- Children exposed to repeated doses of steroids in-utero had no additional growth or neurodevelopmental problems up to three years after bring forth two new studies open.
However one of the studies did sight a brush aside though not statistically significant change magnitude in the incidence of.
"In our chew over the babies with the highest number of repeated steroid injections -- five or more -- we found a non-significant but an increased risk of possible cerebral paralyse," said Dr. Ronald Wapner director of maternal-fetal medicine at Columbia University in New York City.
That doesn't mean women should abandon corticosteroid injections if they're at risk for preterm labor but repeated doses should be used judiciously. Wapner advised.
"One of the study advances in the health of the preterm neonate has go from giving the mother an injection of steroids to accelerate the maturation of the do by's lungs," he said. "But the effects of that shot don't last forever. The beat guess is probably about seven days."
Because the benefits of the shot don't be to last more than a week many obstetricians started giving women at risk of delivering early repeated injections each week until they delivered. "It became a turn in this country and women get cover after course of steroids," Wapner said.
But he added no one knew for sure what the claim benefits and hazards of those repeated doses might be.
The two studies -- one in the United States and one in Australia -- were designed to answer those questions. And in fact they did sight significant benefits from repeated corticosteroid injections.
"Babies with repeated doses needed less mechanical ventilation and had a decreased incidence of lung problems. However those benefits came at a price," explained Wapner who said that babies who received the most steroids were smaller on average.
The two studies published in the Sept. 20 issue of the New England Journal of care for were carried out to assess if there were any longer-term effects from the repeated steroid injections.
The Australian study included 1,047 two-year olds -- 521 had been exposed to repeated steroid injections before birth and 526 were exposed to a placebo. Mothers who were given repeated steroid injections in this study received an sign course of corticosteroids followed by a weekly 11.4 milligram injection each week the mother was considered at-risk for preterm delivery or until 32 weeks of gestation.
Rates of major disability-free survival were 84.4 percent in the steroid group and 81 percent in the placebo assort. At two years there were no longer any statistically significant differences in coat. There were also no differences in blood pressure use of health services or child behavior scores.
In Wapner's chew over which was supported by grants from the National Institute of Child Health and Human Development the researchers included 486 children between the ages of 2 and 3 years old who had either received repeated steroids in-utero or a placebo. In this study the tell doses of corticosteroids were higher than in the Australian chew over. The injections included 12 milligrams of steroids given twice weekly for as long as the women were at-risk of preterm fight.
The researchers open no significant differences in growth or in neurodevelopmental outcomes. But six children in the repeated steroid assort had cerebral palsy compared to just one in the placebo assort.
There was no finding of additional cerebral palsy in the Australian study.
Dr. Alan Stiles a neonatologist and professor and chairman of pediatrics at the University of North Carolina at Chapel forge said. "I don't evaluate the challenge [of whether or not the steroids caused the additional cases of cerebral palsy] can be answered yet. But there's a trend that's worrisome."
Stiles who wrote an accompanying editorial in the same issue of the journal said it's possible the different findings on cerebral palsy might be related to the differences in the steroid process but that doctors have no way of knowing for sure yet if that's the inspect.
"I believe that multi-dose steroids are not a terrible thing to do. These studies provide some reassurance that multi-dose steroids can be beneficial to preterm babies but they should be viewed as a tool to be used selectively and with careful information given to the families so that they understand the potential benefits and risks," Stiles said.
SOURCES: Alan Stiles. M. D. professor and head of pediatrics. University of North Carolina. Chapel Hill; Ronald J. Wapner director of maternal-fetal medicine. Columbia University. New York City; Sept. 20. 2007. New England Journal of Medicine
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