Perinatal Treatment with Corticosteroids and Its Relation with Neurodevelopment in Premature Newborns: A Systematic Review of the Literature

Abstract

Objective: One-third of extremely low birth-weight newborns develop chronic lung disease. Early corticosteroid therapy may reduce this risk, but questions remain about the possible adverse effects, especially on neurodevelopment. Materials and Methods: A bibliographic search of papers recorded in the PubMed, Scopus, and Google Scholar databases was conducted in November 2023. Articles that included the expressions "prenatal and postnatal corticotherapy" and "neurodevelopmental" and "infant, very low birth weight" and published between 2013 and 2023 in Spanish, English, or French were selected for analysis. Those that did not meet the selection criteria or did not refer to meta-analyses, systematic reviews, or experimental or observational studies were excluded. The PRISMA methodology was used for this search. Results: After applying the inclusion and exclusion criteria, 21 articles remained for analysis, which revealed no solid evidence of a relationship between prenatal corticosteroid therapy and neuropsychiatric disorders. However, dose-dependent negative effects on neurodevelopment have been observed, and postnatal corticosteroid therapy is associated with a higher risk of gross motor impairment, with greater side effects when administred early and at high cumulative doses. There is no evidence of postnatal inhaled corticosteroid therapy on neurodevelopment. Conclusion: Evidence suggests that prenatal betamethasone adminisration is not associated with negative effects on neurodevelopment. For very-low-birth-weight newborns, most studies recommend postnatal corticosteroid therapy from 7 days of life, when mechanical ventilation cannot be withdrawn. The review findings suggest that the cumulative effect of corticosteroids on this group of newborns may be considered.

Figure 1.

Study flowchart.