A birth in a family is supposed to be one of those milestones that a family never forgets. It’s supposed to be a happy, joyous time. Unfortunately, this is not the case in all births. Sometimes a child enters the world way before he/she is full term. In hopes of helping the baby survive outside of the womb, doctors are usually very quick to offer steroids to help the baby’s lung development. Surprisingly though, new research shows these steroids may be doing more harm than good.
Side Effects of Steroids
According to a new study in the journal Science Translational Medicine, drugs that help premature babies strengthen their lungs can also impair brain development even at low doses.
A steady rise in the survival rate of prematurely born infants has been accompanied by a rise in impaired conditions, say researchers from the University of California – San Francisco in the published study.
“The American Academy of Pediatrics suggests that low doses of glucocorticoids can continue to be used in premature babies. This study provides new evidence that these drugs, even at low doses, are associated with impaired cerebellar development when given to babies after birth,” said Emily Tam, lead author of the October 19 study and assistant professor at University of California San Francisco School of Medicine.
Women who go into preterm labor are often given the glucocorticoid betamethasone to speed up the baby’s lung maturation and shorten the period of time spent on breathing tubes. After birth, premature babies may receive other glucocorticoids like hydrocortisone or dexamethasone to help them maintain normal blood pressure, as well as boost lung function. These issues are life-threatening if not treated, and so many parents are faced with the tough decision of whether or not to give their baby these drugs.
The American Academy of Pediatrics (AAP) has shifted their advice over the years on the issue of steroids. Based on research in animals showing that exposure to glucocorticoids can impair development of the cerebellum (a brain region important in balance, motor learning, language, and behavior), the AAP in 2002 recommended that these drugs not be given to babies after birth. But newer guidelines released in 2010 by the group now suggest that steroids can be used because there hasn’t been enough evidence to show that they harm humans.
Seeking a clearer picture of the effects of glucocorticoids on the premature brain, Tam and colleagues studied 172 preterm neonatal infants born between 2006 and 2009 who were treated at the University of British Columbia Children’s Hospital and Family Research Institute and the University of California, San Francisco’s Benoiff Children’s Hospital. They used advanced MRI analysis techniques to determine the volume of each baby’s cerebellum.
Reassuringly, the team did not see any side effects in babies whose mothers received betamethasone in labor. On the other hand, the researchers found that both hydrocortisone and dexamethasone, when given to premature babies after birth, were associated with decreased growth of the cerebellum. This part of the brain was 10% smaller in the premature infants who received the steroids than in normal newborns.
The researchers plan to follow the babies until they reach school age to determine if impaired cerebellum growth affects cognition or is linked to brain and nervous system disorders.
This study brings new knowledge to the table that could help doctors and parents make more informed decisions on how to treat preemies.
The researchers concluded that healthcare professionals need to explore alterations in treatment after preterm birth that reduce glucocorticoid exposure and could help decrease the risk of neurological impairment in prematurely born infants. Sadly, there are no alternatives to treatment that would allow physicians to avoid using the steroids completely, researchers said.
“Unfortunately, we don’t have good alternative treatments at this time,” Tam continued.
“Low blood pressure and breathing difficulties are big problems for premature babies, with serious long-term consequences of their own for the baby’s development.”
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