Long-term cognitive benefits of antenatal corticosteroids for prematurely born children with cranial ultrasound abnormalities

Objective: Previous studies have examined possible long-term effects of antenatal corticosteroids, but not by the presence of neonatal brain lesions. This study of long-term neurodevelopmental outcomes of antenatal corticosteroid exposure among preterm, very-low-birth-weight infants investigated whether the effects are differential by the presence of neonatal brain injury. Study design: Prospective cohort study of cognition, behavior, and cerebral palsy in 251 children (ages 6-8 years) born at ≤32 weeks of gestation. This sample included 91 children with abnormal neonatal cranial ultrasound findings and 106 children who had been exposed to antenatal corticosteroids. Results: In children with abnormal cranial ultrasound findings, a complete course of antenatal corticosteroids was associated with an 8.7-point advantage in IQ (95% CI, 1.8, 15.6; P = .016), controlling for confounding factors. Both verbal and nonverbal cognitive scores were increased in a dose-response manner. The advantage was greater for infants born at ≤28 weeks of gestation and in those with ventriculomegaly. In children with normal cranial ultrasound scans, cognitive function was not related to antenatal corticosteroid exposure. No statistically significant associations were observed between antenatal corticosteroid exposure and either childhood behavioral scores or cerebral palsy. Conclusion: Antenatal corticosteroids appear to confer substantial long-term benefits on cognition of very-low-birth-weight infants with cranial ultrasound abnormalities. (Am J Obstet Gynecol 2002;186:818-25.)