Postnatal corticosteroids and sensorineural outcome at 5 years of age

Background: Postnatal corticosteroids reduce ventilator dependence in prete rm infants, but possible long-term benefits for either survival or sensorin eural morbidity are not proved. Aim: The aim of this study was to determine the association between cortico steroid therapy given postnatally and sensorineural outcome in childhood. Subjects: The subjects comprised 346 consecutive livebirths either of birth weight < 1000 g or with gestational age < 28 weeks born in the state of Vic toria during 1991 and 1992, and who survived the first week after birth; 12 0 (34.7%) were given corticosteroids postnatally. Results: Of the 120 children who received corticosteroids, 98 (81.7%) survi ved to 5 years of age, compared with 200 (88.5%) of the 226 children who di d not receive corticosteroids. At 5 years of age, survivors treated with co rticosteroids postnatally had significantly higher rates of cerebral palsy (corticosteroids 23%, no corticosteroids 4%), blindness (corticosteroids 4% , no corticosteroids 1%) or an intelligence quotient more than one standard deviation below the mean (corticosteroids 54%, no corticosteroids 32%) com pared with children not treated with corticosteroids. The rate of sensorine ural disabilities imposed by these impairments was significantly higher in children treated with postnatal corticosteroids, and the association betwee n adverse sensorineural outcome and postnatal corticosteroids remained afte r adjustments for potentially confounding variables. In a separate case-con trol analysis of 60 children in each group, the rate of cerebral palsy rema ined significantly elevated (corticosteroids 22%, no corticosteroids 5%). Conclusion: Postnatal corticosteroid therapy is associated with substantial adverse sensorineural outcomes at 5 years of age.