Safety of steroids for small babies questioned

NEW YORK (Reuters Health) - Treatment with steroids for low blood pressure in very low birth weight (VLBW) infants may increase the risk of brain damage and death, new findings suggest. The researchers call for more forward-looking studies to assess the safety of this treatment.

VLBW infants weight less than 3 lbs. 5 oz and are at increased risk for death and a variety of complications, including lung and heart problems.

Steroids are often given to VLBW infants to prevent or treat lung disease, but recently there has been evidence that they may also help with low blood pressure or "hypotension." Until now, however, no forward-looking studies had looked at the use of steroids for this condition.

As reported in the medical journal Pediatrics, Dr. Neil N. Finer, from the University of California San Diego Medical Center, and colleagues assessed the use of steroids in 1401 VLBW infants entered in a perinatal database in California.

Overall, 3.6 percent of infants received steroids for chronic lung disease only, 11.8 percent for other conditions, and 4.0 percent for lung disease and other conditions, the investigators report. In all birth weight categories, steroids were used mostly for conditions that were unrelated to the lung.

Hypotension was the most common disease unrelated to the lungs treated with steroids, the investigators note. Of the 221 infants given steroids for non-lung disease, 180 received the therapy for hypotension. The most commonly used steroid for hypotension was hydrocortisone, followed by dexamethasone.

When compared with infants given steroids only for chronic lung disease or those not given steroids, infants treated with steroids for hypotension were at increased risk for bleeding in the brain, brain damage, and death.

"There is an urgent need for large, well-designed trials to evaluate the safety and efficacy of postnatal steroids to treat hypotension in VLBW infants and to evaluate both short- and long-term...developmental outcomes in such infants before this practice gains increased use," the authors conclude.

SOURCE: Pediatrics, March 2006.