Steroids are potent drugs used in perinatal medicine to promote lung maturation in preterm infants and treat conditions like chronic lung disease. Antenatal steroids given between 24-34 weeks of gestation reduce the risks of respiratory distress syndrome, intraventricular hemorrhage, and death in preterm infants. Postnatal steroids are used to treat chronic lung disease but have been associated with adverse short and long term effects like gastrointestinal bleeding and cerebral palsy. Steroids are also used to treat conditions like hypotension, hypoglycemia, and surgical conditions such as congenital diaphragmatic hernia in newborns. Further research is still needed to determine the optimal dosage and duration of steroid treatment in

1. dnbpaediatrics.blogspot.in
STEROIDS IN PERINATAL
MEDICINE
Dr Sushmita Ghosh
DNB Pediatrics
Bhilai Steel Plant Hospital

2. Definition
 Perinatal period- period from the 28th
week of gestation through the 7th day of life
 Extended perinatal period-extends from
22nd wk of gestation to 7th day of life.
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3.  Steroids are one of the most potent drugs in
neonatology
 Steroids have immediate physiologic effects
on lung function of preterm infants (Halliday
biol neonate 1999)
 Survey shows 95% neonatologists use steroids
in preterm infants at risk of CLD (Bull et
al,Clin Res 1993)
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4. INDICATIONS
 Antenatal steroids for lung maturation
 Postnatal steroids for CLD(BPD)
 Post extubation laryngeal oedema
 Ionotrope resistant hypotension
 Resistant or persistant hypoglycemia
 Primary adrenal insufficiency
 Surgical conditions
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5. Antenatal steroids
Helps in transition to air breathing by-
 Acceleration of maturation of developmentally
regulated proteins
 Stimulate cytodifferentiation in type II
pneumocytes
 production of surfactant, lung
compliance and maximal lung volume
 Reduces protein leak
 Accelerate clearance of lung liquid
 Preffered –betamethasone
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6. Recommendation
 All pregnant women between 24-34 wks
gestation at risk of delivering within 7 days-
single course of corticosteroids
 Betamethasone 12 mg im 2 doses 24 hrs apart
 Betamethasone better than dexamethasone
because it lowers risk of cystic periventricular
leukomalacia and it significantly decreases
neonatal death
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7. BENEFITS
 RDS
 IVH
 NEC
 Pneumothorax
 Severe ROP
 PDA
 Perinatal Mortality
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8. Effect On BPD?
DOES NOT ALTER INCIDENCE OF
BPD
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9. Benefits of ANS not affected by
-race/gender
-presence of PROM
-there is no incidence of maternal and
neonatal infection
-no alteration in lung mechanics
-on follow up there was no problem
with general health
-no neurodevelopmental delay
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10. CHRONIC LUNG DISEASE
 What is CLD/BPD?
 Infants born at <32 wks gestation who remain in
02 for the first 28 days,
 At 36 wks PMA
-Mild BPD-no 02 requirement
-Mod BPD-supplemental 02
requirement <30%
-severe BPD ≥30% 02,CPAP or
ventilatory support
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11. Infants born at ≥32 wks gestation BPD
defined as supplemental 02 requirement
for the first 28 days with severity level
based on 02 requirement at 56 days
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12. EPIDEMIOLOGY
 infants <1250 grams birth weight are
the most affected
 risk is less in girls and african -
americans
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13. Pathogenesis dnbpaediatrics.blogspot.in
acute lung injury
proinflammatory cytokines
(IL 1β,IL-6,IL-8,TNF- α)
leakage of water and protein
emphysematous changes
collapse, hyperinflation ,peripheral
airway dilation

14. chronic phase of lung injury
release of growth factors
fibrosis, cellular hyperplasia
pulmonary fluid retention
lung Cs, airway resistance
ventilation perfusion mismatch
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15. Chronic lung disease
 Systemic steroids reduce pulmonary
inflammatory mediators
 inhibit synthesis of prostaglandins and
fibronectin
 enhanced surfactant synthesis
 anti-oxidant production
 stabilization of lysosomal and cellular
membranes dnbpaediatrics.blogspot.in

16. Postnatal steroids for prevention of CLD
Group benefits Adverse effects Late outcomes
Early(<96 •Earlier extubation • GI Haemorrhage •Cerebral palsy
• pda • Intestinal •Abnormal
hrs) perforation neurological
• severe rop
• death or CLD • Hyperglycemia examination
• hypertension
Moderately •Earlier extubation • hypertension •No adverse
• mortality and CLD at • Hyperglycemia increase in
early(7-14 neurological
28 days and/or 36 wks • GI bleeding
days) outcome
• Infection
• Hypertrophic
cardiomyopathy
Delayed(>3 • failure to extubate • glycosuria No increase in major
• CLD or death at 36 • hypertension neurosensory
weeks) disability death
wks • ROP
• need for late rescue
therapy with steroids
•discharge to home dnbpaediatrics.blogspot.in
with o2

17. Other Treatment Modalities Of
BPD
-Vitamin A(5000 U IM) for Prevention three
times weekly for the first 28 days in ELBW
-Diuretics
-Bronchodilators
-pain management
-electrolyte supplements
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18. Post extubation laryngeal oedema
 Coricosteroids prevents or treats
 need for subsequent reintubation
 prolonged stay in NICU
 useful in infants with prolonged
intubation >2 weeks,or who had multiple
or traumatic intubations(cochrane systemic
reviews)
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19. Corticosteroids in hypotension
 Systemic hypotension a common problem
in VLBW infants
 Cortisol levels low in VLBW infants
 IVH contributes to hypotension
 In addition to volume replacement and
vasopressors Hydrocortisone has been
successfully used to treat ionotrope resistant
hypotension
 Used in low doses 0.1mg/kg/dose 4 hrly
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20. Corticosteroids in
hypoglycemia
 Useful in resistant or persistent hypoglycemia
 Resistent hypoglycemia is requirement of dextrose
infusion rate>12 mg/kg/min
 Persistent hypoglycemia is hypoglycemia
persisting for more than a week
 Should rule out hyperinsulinemic state or inborn
errors of metabolism
 Hydrocortisone used 5-10 mg/kg/day in two
divided doses iv
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21. SURGICAL CONDITIONS
 Mothers with antenatal diagnosis of CDH
- Betamethasone to be given even if term
gestation
 Cystic adenomatoid malformation of
lung(surfactant deficiency) diagnosed
antenatally by US/MRI-Antenatal steroids
indicated
CONTD.
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22.  HAEMANGIOMA
can be treated with steroids
a)topical
b)intralesional
c)oral
d)parenteral
 Within 1-2 wks 35% show dramatic response,45%
equivocal response
 If no response after 2 wks, should be rapidly tapered
 Intralesional injection preferred in well localized
haemangiomas i.e in eyelids
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23. Research potential and conclusions
 Need to evaluate the use of multiple courses of
antenatal steroids in clinical trials
 Though systemic steroids are useful in
preventing CLD,there is concern regarding
long term neurologic problems
 Further studies are being done to focus on
finding minimum dose and duration of
treatment that will be effective
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