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Objectives
Our objective was to systematically review and meta-analyse long-term neurodevelopmental
and psychological outcomes of children (>1 year) exposed to antenatal corticosteroids
(ACS), with planned stratification by timing of birth.
Methods
We systematically searched seven electronic databases from Jan 2000 (reflecting recent
neonatal care) to June 2020. We included follow-up studies of randomized controlled
trials (RCTs) and cohort studies on neurodevelopmental and psychological outcomes
in ACS-exposed vs unexposed children, and with random-effects meta-analysis, data
permitting.
Results
Thirty-two publications met inclusion criteria (five follow-up studies of three RCTs
and 27 cohort studies). Most studies were published within the last five years with
follow-up of children ranging from 1 to 10 years of age. A total of over 70 outcomes
were identified. Three cohort studies of 2,926 children found that children born preterm
after exposure to a single course of ACS was associated with a significantly decreased
risk of cerebral palsy vs. non-exposure (RR=0.70, 95% CI=0.49-0.99, I2=30%). However,
the largest cohort study (N=670,097) found a higher risk of any mental and behavioral
disorders in preterm/term-born children exposed to ACS vs. those unexposed (absolute
difference=5.56%, 95% CI=5.04%-6.19%; HR=1.33, 95% CI=1.26-1.41; with the largest
effects in term-born children).
Conclusions
While ACS exposure is associated with significantly lower risks of cerebral palsy
after preterm birth, it is also associated with increased mental and behavioral disorders
following preterm or term birth, particularly those at term. These data suggest a
need to consider cautious ACS administration.
Keywords
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© 2021 Published by Elsevier Inc.
