Betamethasone effects on cerebral blood flow

In 2002, the American Academy of Pediatrics and the Canadian Pediatric Society cautioned against the treatment of infants with bronchopulmonary dysplasia with corticosteroids because of concerns about adverse neurodevelopmental outcomes. Although the use of corticosteroids has decreased, they continue to be used because they can have striking effects on ventilator dependent infants, which often result in extubation and decreased oxygen exposure. Prolonged mechanical ventilation also is associated with adverse neurodevelopmental outcomes. Since the 2002 statement, clinicians tend to use lower doses of corticosteroids for shorter periods of time. Also, recent studies suggest that the adverse neurodevelopmental effects of postnatal corticosteroids may be much less of a problem than previously thought. However, the report by Cambonie et al demonstrates a clear and consistent decrease in cerebral blood flow velocities in preterm infants with severe lung disease when the treatment with betamethasone occurred at about one month of age. The effect was reversible. This initial observation in a small number of patients does not provide any information about the effect of the changes in cerebral blood flow velocity on outcomes. It does suggest that further studies are warranted. The major variables that need to be studied are the choice of corticosteroid (dexamethasone, betamethasone, hydrocortisone, other?), the minimal effective doses, and the minimal treatment intervals for the indication of corticosteroids to improve lung function in infants with bronchopulmonary dysplasia.

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