Steroids and it's effects

[selvanr4]

i wonder always about the use of steroids in peripartum period about it's side effects and effects.
1. When antenatal steroids are harmless and help in reducing RDS how post natal steroids have become dangerous in RDS ?

2.When steroids are used for BPD without serious consequences how the same steroid is dangerous if used post natally for RDS ?


I will be happy to get the right answers for this nagging questions.

thanks
selvan rathinasmy
ERODE,INDIA

[JACK]

A nice look at the concept behind the harmful effect of post natal steroids ( is it steroids or the sulphite ??? which is the culprit)


Postnatal steroid treatment and brain development.Arch Dis Child Fetal Neonatal Ed 2004;89:F96–F100. doi: 10.1136/adc.2003.028696
FREE LINK (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1756046&blobtype=pdf)

Nice reviews of current knowledge regarding antenatal steroid use


Antenatal corticosteroid treatment: what's happened since Drs Liggins and Howie?
Bonanno C, Wapner RJ.
Am J Obstet Gynecol. 2009 Apr;200(4):448-57.
LINK (http://www.ncbi.nlm.nih.gov/pubmed/19318156?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)

Single versus repeat courses of antenatal steroids to improve neonatal outcomes: risks and benefits.
Bonanno C, Fuchs K, Wapner RJ.
Obstet Gynecol Surv. 2007 Apr;62(4):261-71. Review.
LINK (http://www.ncbi.nlm.nih.gov/pubmed/17371606?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)


Antenatal steroid use may also have deleterious neurological /behavioural effect on the baby when multiple doses are given


Leung, Tse N., Lam, Po M., Ng, Pak C. and Lau, Tze K.(2003)'Repeated courses of antenatal corticosteroids: Is it justified?',Acta Obstetricia et Gynecologica Scandinavica,82:7,589 — 596
LINK (http://www3.interscience.wiley.com/journal/118826748/abstract)

Repeated antenatal corticosteroids: effects on cerebral palsy and childhood behavior.
French NP, Hagan R, Evans SF, Mullan A, Newnham JP.
Am J Obstet Gynecol. 2004 Mar;190(3):588-95.
LINK (http://www.ncbi.nlm.nih.gov/pubmed/15041985?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)

Two-year infant neurodevelopmental outcome after single or multiple antenatal courses of corticosteroids to prevent complications of prematurity.
Spinillo A, Viazzo F, Colleoni R, Chiara A, Maria Cerbo R, Fazzi E.
Am J Obstet Gynecol. 2004 Jul;191(1):217-24.
LINK (http://www.ncbi.nlm.nih.gov/pubmed/15295369?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)

Long-term outcomes after repeat doses of antenatal corticosteroids.
Wapner RJ, Sorokin Y, Mele L, Johnson F, Dudley DJ, Spong CY, Peaceman AM, Leveno KJ, Malone F, Caritis SN, Mercer B, Harper M, Rouse DJ, Thorp JM, Ramin S, Carpenter MW, Gabbe SG; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.
N Engl J Med. 2007 Sep 20;357(12):1190-8.
FREE LINK (http://content.nejm.org/cgi/reprint/357/12/1190.pdf)

Adverse neonatal outcomes associated with antenatal dexamethasone versus antenatal betamethasone.
Lee BH, Stoll BJ, McDonald SA, Higgins RD; National Institute of Child Health and Human Development Neonatal Research Network.
Pediatrics. 2006 May;117(5):1503-10.
FREE LINK (http://www.ncbi.nlm.nih.gov/pubmed/16651303?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum&log$=freejrpmc)

One thing that I can guarantee you selvan, is that after you read all these reviews/articles, you will end up having more nagging questions than when you had started !!

[selvanr4]

thanks a lot Jack!
i will be back after reading through the articles
selvan

[selvanr4]

i found out a cochrane review which supports antenatal steroids;
http://www.cochrane.org/reviews/CD004454.pdf

[JACK]

Single dose of antenatal steroids is safe but the problem comes when multiple/repeated doses/courses of antenatal steroids are given