i wonder always about the use of steroids in peripartum period about it's side effects and effects.

1. When antenatal steroids are harmless and help in reducing RDS how post natal steroids have become dangerous in RDS ?

2.When steroids are used for BPD without serious consequences how the same steroid is dangerous if used post natally for RDS ?

I will be happy to get the right answers for this nagging questions.

thanks

selvan rathinasmy

ERODE,INDIA

A nice look at the concept behind the harmful effect of post natal steroids ( is it steroids or the sulphite ??? which is the culprit)

Postnatal steroid treatment and brain development.Arch Dis Child Fetal Neonatal Ed 2004;89:F96–F100. doi: 10.1136/adc.2003.028696

FREE LINK

Nice reviews of current knowledge regarding antenatal steroid use

Antenatal corticosteroid treatment: what's happened since Drs Liggins and Howie?

Bonanno C, Wapner RJ.

Am J Obstet Gynecol. 2009 Apr;200(4):448-57.

LINK

Single versus repeat courses of antenatal steroids to improve neonatal outcomes: risks and benefits.

Bonanno C, Fuchs K, Wapner RJ.

Obstet Gynecol Surv. 2007 Apr;62(4):261-71. Review.

LINK

Antenatal steroid use may also have deleterious neurological /behavioural effect on the baby when multiple doses are given

Leung, Tse N., Lam, Po M., Ng, Pak C. and Lau, Tze K.(2003)'Repeated courses of antenatal corticosteroids: Is it justified?',Acta Obstetricia et Gynecologica Scandinavica,82:7,589 — 596

LINK

Repeated antenatal corticosteroids: effects on cerebral palsy and childhood behavior.

French NP, Hagan R, Evans SF, Mullan A, Newnham JP.

Am J Obstet Gynecol. 2004 Mar;190(3):588-95.

LINK

Two-year infant neurodevelopmental outcome after single or multiple antenatal courses of corticosteroids to prevent complications of prematurity.

Spinillo A, Viazzo F, Colleoni R, Chiara A, Maria Cerbo R, Fazzi E.

Am J Obstet Gynecol. 2004 Jul;191(1):217-24.

LINK

Long-term outcomes after repeat doses of antenatal corticosteroids.

Wapner RJ, Sorokin Y, Mele L, Johnson F, Dudley DJ, Spong CY, Peaceman AM, Leveno KJ, Malone F, Caritis SN, Mercer B, Harper M, Rouse DJ, Thorp JM, Ramin S, Carpenter MW, Gabbe SG; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.

N Engl J Med. 2007 Sep 20;357(12):1190-8.

FREE LINK

Adverse neonatal outcomes associated with antenatal dexamethasone versus antenatal betamethasone.

Lee BH, Stoll BJ, McDonald SA, Higgins RD; National Institute of Child Health and Human Development Neonatal Research Network.

Pediatrics. 2006 May;117(5):1503-10.

FREE LINK

One thing that I can guarantee you selvan, is that after you read all these reviews/articles, you will end up having more nagging questions than when you had started !!

thanks a lot Jack!

i will be back after reading through the articles

selvan

i found out a cochrane review which supports antenatal steroids;

http://www.cochrane.org/reviews/CD004454.pdf

Single dose of antenatal steroids is safe but the problem comes when multiple/repeated doses/courses of antenatal steroids are given