Mid-childhood outcomes of repeat antenatal corticosteroids: A randomized controlled trial

Caroline A. Crowther, Peter J. Anderson, Christopher J D McKinlay, Jane E. Harding, Pat J. Ashwood, Ross R. Haslam, Jeffery S. Robinson, Lex W. Doyle

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: To assess if exposure to repeat dose(s) of antenatal corticosteroids has beneficial effects on neurodevelopment and general health in mid-childhood, at 6 to 8 years corrected age. METHODS: Women at risk for very preterm birth, who had received a course of corticosteroids ≥7 days previously, were randomized to intramuscular betamethasone (11.4 mg Celestone Chronodose) or saline placebo, repeated weekly if risk of very preterm birth remained. Midchildhood assessments included neurocognitive function, behavior, growth, lung function, blood pressure, health-related quality of life, and health service utilization. The primary outcome was survival free of neurosensory disability. RESULTS: Of the 1059 eligible long-term survivors, 963 (91%) were included in the primary outcome; 479 (91%) in the repeat corticosteroid group and 484 (91%) in the placebo group. The rate of survival free of neurosensory disability was similar in both groups (78.3% repeat versus 77.3% placebo; risk ratio 1.00, 95% confidence interval, 0.94-1.08). Neurodevelopment, including cognitive function, and behavior, body size, blood pressure, spirometry, and health-related quality of life were similar in both groups, as was the use of health services. CONCLUSIONS: Treatment with repeat dose(s) of antenatal corticosteroids was associated with neither benefit nor harm in mid-childhood. Our finding of long-term safety supports the use of repeat dose(s) of antenatal corticosteroids, in view of the related neonatal benefits. For women at risk for preterm birth before 32 weeks gestation, ≥7 days after an initial course of antenatal corticosteroids, clinicians could consider using a single injection of betamethasone, repeated weekly if risk remains.

Original languageEnglish
Article numbere20160947
Number of pages10
JournalPediatrics
Volume138
Issue number4
DOIs
Publication statusPublished - Oct 2016
Externally publishedYes

Cite this

Crowther, C. A., Anderson, P. J., McKinlay, C. J. D., Harding, J. E., Ashwood, P. J., Haslam, R. R., ... Doyle, L. W. (2016). Mid-childhood outcomes of repeat antenatal corticosteroids: A randomized controlled trial. Pediatrics, 138(4), [e20160947]. https://doi.org/10.1542/peds.2016-0947
Crowther, Caroline A. ; Anderson, Peter J. ; McKinlay, Christopher J D ; Harding, Jane E. ; Ashwood, Pat J. ; Haslam, Ross R. ; Robinson, Jeffery S. ; Doyle, Lex W. / Mid-childhood outcomes of repeat antenatal corticosteroids : A randomized controlled trial. In: Pediatrics. 2016 ; Vol. 138, No. 4.
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abstract = "Objective: To assess if exposure to repeat dose(s) of antenatal corticosteroids has beneficial effects on neurodevelopment and general health in mid-childhood, at 6 to 8 years corrected age. METHODS: Women at risk for very preterm birth, who had received a course of corticosteroids ≥7 days previously, were randomized to intramuscular betamethasone (11.4 mg Celestone Chronodose) or saline placebo, repeated weekly if risk of very preterm birth remained. Midchildhood assessments included neurocognitive function, behavior, growth, lung function, blood pressure, health-related quality of life, and health service utilization. The primary outcome was survival free of neurosensory disability. RESULTS: Of the 1059 eligible long-term survivors, 963 (91{\%}) were included in the primary outcome; 479 (91{\%}) in the repeat corticosteroid group and 484 (91{\%}) in the placebo group. The rate of survival free of neurosensory disability was similar in both groups (78.3{\%} repeat versus 77.3{\%} placebo; risk ratio 1.00, 95{\%} confidence interval, 0.94-1.08). Neurodevelopment, including cognitive function, and behavior, body size, blood pressure, spirometry, and health-related quality of life were similar in both groups, as was the use of health services. CONCLUSIONS: Treatment with repeat dose(s) of antenatal corticosteroids was associated with neither benefit nor harm in mid-childhood. Our finding of long-term safety supports the use of repeat dose(s) of antenatal corticosteroids, in view of the related neonatal benefits. For women at risk for preterm birth before 32 weeks gestation, ≥7 days after an initial course of antenatal corticosteroids, clinicians could consider using a single injection of betamethasone, repeated weekly if risk remains.",
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Crowther, CA, Anderson, PJ, McKinlay, CJD, Harding, JE, Ashwood, PJ, Haslam, RR, Robinson, JS & Doyle, LW 2016, 'Mid-childhood outcomes of repeat antenatal corticosteroids: A randomized controlled trial' Pediatrics, vol. 138, no. 4, e20160947. https://doi.org/10.1542/peds.2016-0947

Mid-childhood outcomes of repeat antenatal corticosteroids : A randomized controlled trial. / Crowther, Caroline A.; Anderson, Peter J.; McKinlay, Christopher J D; Harding, Jane E.; Ashwood, Pat J.; Haslam, Ross R.; Robinson, Jeffery S.; Doyle, Lex W.

In: Pediatrics, Vol. 138, No. 4, e20160947, 10.2016.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Crowther, Caroline A.

AU - Anderson, Peter J.

AU - McKinlay, Christopher J D

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AU - Ashwood, Pat J.

AU - Haslam, Ross R.

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AU - Doyle, Lex W.

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N2 - Objective: To assess if exposure to repeat dose(s) of antenatal corticosteroids has beneficial effects on neurodevelopment and general health in mid-childhood, at 6 to 8 years corrected age. METHODS: Women at risk for very preterm birth, who had received a course of corticosteroids ≥7 days previously, were randomized to intramuscular betamethasone (11.4 mg Celestone Chronodose) or saline placebo, repeated weekly if risk of very preterm birth remained. Midchildhood assessments included neurocognitive function, behavior, growth, lung function, blood pressure, health-related quality of life, and health service utilization. The primary outcome was survival free of neurosensory disability. RESULTS: Of the 1059 eligible long-term survivors, 963 (91%) were included in the primary outcome; 479 (91%) in the repeat corticosteroid group and 484 (91%) in the placebo group. The rate of survival free of neurosensory disability was similar in both groups (78.3% repeat versus 77.3% placebo; risk ratio 1.00, 95% confidence interval, 0.94-1.08). Neurodevelopment, including cognitive function, and behavior, body size, blood pressure, spirometry, and health-related quality of life were similar in both groups, as was the use of health services. CONCLUSIONS: Treatment with repeat dose(s) of antenatal corticosteroids was associated with neither benefit nor harm in mid-childhood. Our finding of long-term safety supports the use of repeat dose(s) of antenatal corticosteroids, in view of the related neonatal benefits. For women at risk for preterm birth before 32 weeks gestation, ≥7 days after an initial course of antenatal corticosteroids, clinicians could consider using a single injection of betamethasone, repeated weekly if risk remains.

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Crowther CA, Anderson PJ, McKinlay CJD, Harding JE, Ashwood PJ, Haslam RR et al. Mid-childhood outcomes of repeat antenatal corticosteroids: A randomized controlled trial. Pediatrics. 2016 Oct;138(4). e20160947. https://doi.org/10.1542/peds.2016-0947