Korean J Pediatr.  2014 Mar;57(3):101-109. 10.3345/kjp.2014.57.3.101.

Evidence for adverse effect of perinatal glucocorticoid use on the developing brain

• Chang YP

• KMID: 1702648
• DOI: http://doi.org/10.3345/kjp.2014.57.3.101

Abstract

The use of glucocorticoids (GCs) in the perinatal period is suspected of being associated with adverse effects on long-term neurodevelopmental outcomes for preterm infants. Repeated administration of antenatal GCs to mothers at risk of preterm birth may adversely affect fetal growth and head circumference. Fetal exposure to excess GCs during critical periods of brain development may profoundly modify the limbic system (primarily the hippocampus), resulting in long-term effects on cognition, behavior, memory, co-ordination of the autonomic nervous system, and regulation of the endocrine system later in adult life. Postnatal GC treatment for chronic lung disease in premature infants, particularly involving the use of dexamethasone, has been shown to induce neurodevelopmental impairment and increases the risk of cerebral palsy. In contrast to studies involving postnatal dexamethasone, long-term follow-up studies for hydrocortisone therapy have not revealed adverse effects on neurodevelopmental outcomes. In experimental studies on animals, GCs has been shown to impair neurogenesis, and induce neuronal apoptosis in the immature brains of newborn animals. A recent study has demonstrated that dexamethasone-induced hypomyelination may result from the apoptotic degeneration of oligodendrocyte progenitors in the immature brain. Thus, based on clinical and experimental studies, there is enough evidence to advice caution regarding the use of GCs in the perinatal period; and moreover, the potential long-term effects of GCs on brain development need to be determined.

Keyword

Glucocorticoids; Dexamethasone; Hydrocortisone; Fetus; Newborn infant

MeSH Terms

Adult
Animals
Animals, Newborn
Apoptosis
Autonomic Nervous System
Brain*
Cerebral Palsy
Cognition
Critical Period (Psychology)
Dexamethasone
Endocrine System
Fetal Development
Fetus
Follow-Up Studies
Glucocorticoids
Head
Humans
Hydrocortisone
Infant, Newborn
Infant, Premature
Limbic System
Lung Diseases
Memory
Mothers
Neurogenesis
Neurons
Oligodendroglia
Premature Birth
Dexamethasone
Glucocorticoids
Hydrocortisone