Two-year infant neurodevelopmental outcome after single or multiple antenatal courses of corticosteroids to prevent complications of prematurity

Spinillo, Arsenio; Viazzo, Franco; Colleoni, Rossella; Chiara, A; Cerbo, Rosa Maria; Fazzi, Elisa

doi:10.1016/j.ajog.2003.12.023

Cited by 131 publications

(74 citation statements)

References 24 publications

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“…These results are similar to those reported in the literature, 17,18 as the presence of abnormal movements at three months of age is associated with prematurity 19 .…”

Section: Discussionsupporting

confidence: 83%

Factors Related to Motor Developmental Delay of Newborns

Silva

Neves

Frônio

et al. 2014

J. Hum. Growth Dev.

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Artigo baseado em dissertação de mestrado cujos resultados, discussão e resultados serão apresentados em forma de artigos sendo este um deles. Defesa em 2011. Instituição UFJF. INTRODUCTIONSystematic evaluation of motor changes and associated morbidities in neonates in the Neonatal Intensive Care Unit (NICU) may provide important information about neurodevelopmental outcomes 1 and may accelerate the initiation of intervention and facilitate the future development of these children 2 . The number of adverse morbidities in the peri-and neonatal periods increases the risk of delayed developmental changes between 18 and 24 months of corrected age 3 . Studies demonstrate that newborns from the NICU, mainly the extremely preterm newborns, may have delay in their neuromotor and cognitive development due to their biological characteristics (such as gestational age and birth weight) 4,5 or interventions and complications in the peri-and neonatal periods [6][7][8] . Identifying factors which may increase an infant's risk of delay would allow clinicians to focus on children with higher risk and would also allow the enforcement of preventive measures aiming at avoiding the occurrence of such factors.Evaluations of the practices carried out in the maternal and infant units are widely discussed in developed countries. In developing countries, systematic evaluation is just beginning, and data is available through databases such as the Vermont Oxford Network and the Brazilian Net of Neonatal Research 9 .Studies about the relationship between the delay in developmental motor and events observed during the neonatal period usually involve clinical assessments carried out after hospital discharge. In such cases, the links identified might suffer from the interference of factors that took place between discharge from the NICU and the assessment: socioeconomic and stimulation conditions. Assessing the newborns before hospital discharge may prevent these effects.A development evaluation at the time of discharge from the NICU couldbe used by hospital service to evaluate the discharge conditions of its users and to improve services quality, preventing risk factors to motor development delay in newborns. The aim of this study is to verify the . ABSTRACT Introduction: Studies on the association between motor developmental delay and events observed during the neonatal period are performed after discharge. In such cases, the associations found may be interfered by factors occurring between discharge from the NICU and evaluation. Evaluate newborns before hospital discharge can prevent these effects.The purpose of this study is to identify factors related to motor developmental delay of newborns when being discharged from Neonatal Intensive Care Unit. The method chosen to carry out this investigation was a prospective cohort, populationbased and analytic-descriptive study, and 178 newborns were assessed through the Test of Infant Motor Performance. Binomial logistic regression has been developed for analyzing the associated factors. Among th...

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“…These results are similar to those reported in the literature, 17,18 as the presence of abnormal movements at three months of age is associated with prematurity 19 .…”

Section: Discussionsupporting

confidence: 83%

Factors Related to Motor Developmental Delay of Newborns

Silva

Neves

Frônio

et al. 2014

J. Hum. Growth Dev.

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“…A magnetic resonance imaging study in human newborns suggested that exposure to repeated courses (Ն2 courses of 24 mg of betamethasone) to mothers at risk of preterm labor was associated with decreased cortical surface complexity (28). The results of postnatal studies of preterm human offspring exposed to repeated courses of antenatal steroids for threatened preterm labor are inconsistent, as a number of studies demonstrated no major untoward effects at 2 years of age (8,29,30), but others demonstrated a higher incidence of cerebral palsy (31), behavioral abnormalities, and/or attention issues (30,32,33).…”

Section: Discussionmentioning

confidence: 99%

Prenatal Anti‐Ro Antibody Exposure, Congenital Complete Atrioventricular Heart Block, and High‐Dose Steroid Therapy: Impact on Neurocognitive Outcome in School‐Age Children

Kelly

Sananes

Chiu‐Man

et al. 2014

Arthritis & Rheumatology

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Objective. To determine the impact of prenatal exposure to maternal anti-Ro antibodies, slow fetal heart rate, and/or prolonged dexamethasone therapy for immune-mediated congenital atrioventricular heart block (CAVB) on the cognitive and academic performance of these children at school age.Methods. We performed a prospective, blinded assessment of the cognitive functioning of 3 cohorts of children ages 6-16 years with in utero exposure to maternal anti-Ro antibodies in the following groups: no CAVB and no prenatal dexamethasone treatment (n ‫؍‬ 14), CAVB without prenatal treatment (n ‫؍‬ 10), and CAVB with prenatal dexamethasone treatment (n ‫؍‬ 16). Domains assessed included intelligence, visual perceptual and visual motor skills, auditory and visual attention, verbal learning and memory, visual memory, executive function, and behavior.Results. All cohorts scored within the normal range and were not significantly different in terms of intelligence scores, verbal comprehension, perceptional reasoning, working memory, and processing speed. For children with CAVB who were treated prenatally, there were no significant associations between the neurocognitive function scores, the minimal fetal heart rate (range 47-80 beats per minute), and either the duration (range 2-15 weeks) or dosage (range 56-824 mg) of dexamethasone therapy.Conclusion. CAVB and transplacental treatment with dexamethasone was not associated with neurocognitive impairment in school-age children. Larger numbers of children are needed to validate our observation, and assessment of other cognitive abilities is warranted.

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“…Multiple courses of corticosteroids did not improve outcome but have been associated with higher incidence of chorioamnionitis, severe IVH, intra-uterine growth restriction and impaired postnatal stress regulation [9,10]. Based on epidemiologic data, prenatal corticosteroid use has been implicated in long-term programming of the foetus leading to increased risk of cardiovascular, metabolic and neuroendocrine disorders in adult life [11,12].…”

Section: Introductionmentioning

confidence: 99%

Antenatal Dexamethasone Treatment Leads to Changes in Gene Expression in a Murine Late Placenta

Baisden

Sonne

Joshi³

et al. 2007

Placenta

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Antenatal steroids like dexamethasone (DEX) are used to augment foetal lung maturity and there is a major concern that they impair foetal growth. If delivery is delayed after using antenatal DEX, placental function and hence foetal growth may be compromised even further. To investigate the effects of DEX on placental function, we treated 9 pregnant C57/BL6 mice with DEX and 9 pregnant mice were injected with saline to serve as controls. Placental gene expression was studied using microarrays in 3 pairs and other 6 pairs were used to confirm microarray results by semi-quantitative RT-PCR, real-time PCR, in situ hybridization, western blot analysis and Oligo ApopTaq assay. DEXtreated placentas were hydropic, friable, pale, and weighed less (80.0±15.1 mg compared to 85.6.8 ±7.6 mg, p=0.05) (n=62 placentas). Foetal weight was significantly reduced after DEX use (940±32 mg compared to 1162±79 mg, p=0.001) (n=62 foetuses). There was > 99% similarity within and between the three gene chip data sets. DEX led to down-regulation of 1212 genes and up-regulation of 1382 genes. RT-PCR studies showed that DEX caused a decrease in expression of genes involved in cell division such as cyclins A2, B1, D2, cdk 2, cdk 4 and M-phase protein kinase along with growth-promoting genes such as EGF-R, BMP4 and IGFBP3. Oligo ApopTaq assay and western blot studies showed that DEX-treatment increased apoptosis of trophoblast cells. DEX-treatment led to up-regulation of aquaporin 5 and tryptophan hydroxylase genes as confirmed by real-time PCR, and in situ hybridization studies. Thus antenatal DEX treatment led to a reduction in placental and foetal weight, and this effect was associated with a decreased expression of several growth-promoting genes and increased apoptosis of trophoblast cells.

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Two-year infant neurodevelopmental outcome after single or multiple antenatal courses of corticosteroids to prevent complications of prematurity

Cited by 131 publications

References 24 publications

Factors Related to Motor Developmental Delay of Newborns

Factors Related to Motor Developmental Delay of Newborns

Prenatal Anti‐Ro Antibody Exposure, Congenital Complete Atrioventricular Heart Block, and High‐Dose Steroid Therapy: Impact on Neurocognitive Outcome in School‐Age Children

Antenatal Dexamethasone Treatment Leads to Changes in Gene Expression in a Murine Late Placenta

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