%0 Journal Article %1 Barrington2001b %A Barrington, K. J. %D 2001 %J BMC Pediatr %K Adrenal Cortex Hormones; Bronchopulmonary Dysplasia; Cerebral Palsy; Chronic Disease; Humans; Infant; Infant, Newborn; Premature, Diseases; Lung Nervous System Risk Assessment; Survival Rate %P 1 %T The adverse neuro-developmental effects of postnatal steroids in the preterm infant: a systematic review of RCTs. %V 1 %X BACKGROUND: Recent reports have raised concerns that postnatal steroids may cause neuro-developmental impairment in preterm infants. This systematic review was performed with the objective of determining whether glucocorticoid therapy, to prevent or treat bronchopulmonary dysplasia, impairs neuro-developmental outcomes in preterm infants. METHOD: A systematic review of the literature was performed. Medline was searched and articles retrieved using predefined criteria. Data from randomized controlled trials with adequate neuro-developmental follow up (to at least one year) were entered into a meta-analysis to determine the effects of postnatal treatment of preterm infants with glucocorticoids. Cerebral palsy rates, and neuro-developmental impairment (developmental score more than 2SD below the mean, or cerebral palsy or blindness) were analyzed. The studies were divided into 2 groups according to the extent of contamination of the results by treatment of controls with steroids after the initial study period, those with less than 30\% contamination, and those with more than 30\% contamination or size of contamination not reported. RESULTS: Postnatal steroid therapy is associated with an increase in cerebral palsy and neuro-developmental impairment. The studies with less contamination show a greater effect of the steroids, consistent with a real direct toxic effect of steroids on the developing central nervous system. The typical relative risk for the development of cerebral palsy derived from studies with less than 30\% contamination is 2.86 (95\% CI 1.95, 4.19). The typical relative risk for the development of neuro-developmental disability among followed up infants from studies with less than 30\% contamination is 1.66 (95\% CI 1.26, 2.19). From this subgroup of studies, the number of premature infants who need to be treated to have one more infant with cerebral palsy (number needed to harm, NNH) is 7; to have one more infant with neuro-developmental impairment the NNH is 11. CONCLUSIONS: Postnatal pharmacologic steroid treatment for prevention or treatment of bronchopulmonary dysplasia is associated with dramatic increases in neuro-developmental impairment. As there is no clear evidence in the literature of long term benefit, their use for this indication should be abandoned.

@article{Barrington2001b, abstract = {BACKGROUND: Recent reports have raised concerns that postnatal steroids may cause neuro-developmental impairment in preterm infants. This systematic review was performed with the objective of determining whether glucocorticoid therapy, to prevent or treat bronchopulmonary dysplasia, impairs neuro-developmental outcomes in preterm infants. METHOD: A systematic review of the literature was performed. Medline was searched and articles retrieved using predefined criteria. Data from randomized controlled trials with adequate neuro-developmental follow up (to at least one year) were entered into a meta-analysis to determine the effects of postnatal treatment of preterm infants with glucocorticoids. Cerebral palsy rates, and neuro-developmental impairment (developmental score more than 2SD below the mean, or cerebral palsy or blindness) were analyzed. The studies were divided into 2 groups according to the extent of contamination of the results by treatment of controls with steroids after the initial study period, those with less than 30\% contamination, and those with more than 30\% contamination or size of contamination not reported. RESULTS: Postnatal steroid therapy is associated with an increase in cerebral palsy and neuro-developmental impairment. The studies with less contamination show a greater effect of the steroids, consistent with a real direct toxic effect of steroids on the developing central nervous system. The typical relative risk for the development of cerebral palsy derived from studies with less than 30\% contamination is 2.86 (95\% CI 1.95, 4.19). The typical relative risk for the development of neuro-developmental disability among followed up infants from studies with less than 30\% contamination is 1.66 (95\% CI 1.26, 2.19). From this subgroup of studies, the number of premature infants who need to be treated to have one more infant with cerebral palsy (number needed to harm, NNH) is 7; to have one more infant with neuro-developmental impairment the NNH is 11. CONCLUSIONS: Postnatal pharmacologic steroid treatment for prevention or treatment of bronchopulmonary dysplasia is associated with dramatic increases in neuro-developmental impairment. As there is no clear evidence in the literature of long term benefit, their use for this indication should be abandoned.}, added-at = {2014-07-19T17:54:17.000+0200}, author = {Barrington, K. J.}, biburl = {https://www.bibsonomy.org/bibtex/21d1bbcc4190dd3e0aaedf4640aeb14d6/ar0berts}, groups = {public}, interhash = {ef27065754833b348088d68cb3a63795}, intrahash = {1d1bbcc4190dd3e0aaedf4640aeb14d6}, journal = {BMC Pediatr}, keywords = {Adrenal Cortex Hormones; Bronchopulmonary Dysplasia; Cerebral Palsy; Chronic Disease; Humans; Infant; Infant, Newborn; Premature, Diseases; Lung Nervous System Risk Assessment; Survival Rate}, pages = 1, pmid = {11248841}, timestamp = {2014-07-19T18:02:08.000+0200}, title = {The adverse neuro-developmental effects of postnatal steroids in the preterm infant: a systematic review of RCTs.}, username = {ar0berts}, volume = 1, year = 2001 }