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Increase of steroid exposure in newborns

After the Antenatal Late Preterm Steroid (ALPS) trial showed a decrease in respiratory complications following steroid administration, steroid exposure among newborns increased.

Steroid exposure in term newborns increased after circulation of the Antenatal Late Preterm Steroid (ALPS) trial, according to a recent analysis.

The increase of late preterm steroid administration after the trial was more than 2-fold. In the trial, the risk of respiratory complications in preterm infants born between 34-and 36-weeks’ gestation decreased after betamethasone administration.

Preterm birth is difficult to predict, making the practice of increased steroid administration potentially associated with an increase in newborn exposure to steroids. There is little information about how long-term neurodevelopmental outcomes are affected in newborns exposed to steroids.

Investigators conducted a cross-sectional study to determine how the ALPS trial affected newborn steroid exposure. Parents delivering an infant with a gestational age of 37 to 41 weeks from February 2015 to October 2017 underwent an interrupted time series (ITS) analysis. Infants were live, singleton, and term.

Data for the ITS analysis was gathered from the National Center for Health Statistics, which contains publicly available natality data in the United States. ALPS trial circulation was defined as the primary exposure, and the primary outcome was antenatal steroid exposure. Exposure data was gathered for the year before and after circulation of the ALPS trial.

There were 8,729,430 term neonates in the study, 3,135,974 of which were evaluated before ALPS circulation and 3,153,526 after ALPS circulation. Steroid exposure saw a 78% increase in the periods before and after circulation. On average there was a 1% increase in steroid exposure per month.

This evidence showed that steroid exposure increased after circulation of the ALPS trial. In the ALPS trial, the risk of preterm delivery was 16% with strict criteria and 30% with less strict criteria. Investigators hypothesized that the increase in steroid exposure could be related to the challenges in accurately predicting preterm births.

As there is still little evidence on the long-term risks of steroid exposure among newborns, the Society for Maternal-Fetal Medicine recommended that steroids not be administered to patients who likely will not deliver preterm.

Reference

Freret TS, James KE, Melamed A, Gyamfi-Bannerman C, Kaimal AJ, Clapp MA. Antenatal steroid exposure among term newborns. JAMA Pediatr. 2022;176(12):1260–1261. doi:10.1001/jamapediatrics.2022.3251