Motherisk update: Controversies in antenatal corticosteroid treatment

QUESTION: I am following up a former preterm infant, born at 29 weeks' gestation after premature labour. This infant had a relatively benign hospital course and when discharged was not thought to have any complications of prematurity. Despite this, at 1 year old his neurologic examination is abnormal: head circumference is on the 3rd percentile for age (weight on the 25th percentile), and he has increased tone in his lower legs and a moderate developmental delay. His discharge letter indicated that he was exposed antenatally to many doses of dexamethasone. Could this have adversely influenced his neurologic outcome? ANSWER: Antenatal steroids are proven therapy for preventing respiratory distress syndrome and decrease both morbidity and mortality associated with prematurity. Use of multiple doses of antenatal steroids might adversely affect neurologic outcome. There is insufficient evidence to support routine use of multiple doses of antenatal steroids when delivery of a preterm infant is anticipated.