Welcome to the 9th EAPS Congress Programme Scheduling

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For 30 years, antenatal corticosteroids (ACS) have been the standard of care for women at risk of imminent preterm birth (PTB). Robust, high-certainty evidence indicates that timely administration of ACS before imminent PTB reduces the most significant adverse outcomes from PTB, regardless of resource setting.

Despite widespread global use of ACS, significant knowledge gaps surround their safety, long-term effects, optimal timing and dosage. Almost half of women given ACS give birth outside the “therapeutic window” and remain undelivered over 7 days later. The population offered ACS has expanded over time, and ranges from women at 22 to 38 weeks’ gestation, with singleton or multiple pregnancies, even when the absolute risk of impending delivery is relatively low. Additionally, most trials included in the recent Cochrane systematic review on ACS before PTB were undertaken over 25 years ago, during a different era of neonatal care. Overtreatment with ACS is a concern, as evidence emerges of risks of potentially unnecessary ACS exposure.

In this presentation, I will review the current evidence for the short- and long-term benefits and safety of ACS exposure for neonates and children. I will consider the major ongoing challenges surrounding ACS administration, and discuss potential strategies to overcome them.

Key findings from the “Co-OPT ACS cohort”, the largest international birth cohort to date comprising data on ACS exposure and on perinatal and childhood outcomes, will be discussed. This cohort was created by the Consortium for the Study of Pregnancy Treatments (Co-OPT) to address key research questions on ACS, through linkage and harmonisation of population-based data on mothers, babies and children. It contains 2.28 million pregnancies and babies from 3 continents; its large scale and international representation enables review of rare outcomes, such as perinatal mortality, and longitudinal follow-up allows comprehensive evaluation of neonatal and childhood outcomes associated with ACS.

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In the past few decades the neonatal community has achieved the gradual decrease of the threshold of viability and an increased survival of all extremely preterm infants. These events explain the rising incidence of chronic respiratory morbidity in these infants with immediate life-limiting effects and lifelong consequences in the survivors. Postnatal corticosteroids are commonly administered systemically to prevent and treat evolving or established bronchopulmonary dysplasia (BPD) in mechanically ventilated prematurely-born infants. Despite historical reservations and some reluctance to use systemic steroids in everyday clinical care, systemic corticosteroids administered late (after 7 days) have been proven to reduce neonatal mortality and BPD without increasing the risk of necrotising enterocolitis or the combined risk of death and cerebral palsy. In this session we will aim to summarise their intended mechanism of action and their numerous side effects focusing on the potential impact of these potent systemic agents on normal development. We will also review recent evidence that highlight an enhanced understanding of their mechanism of action. Finally we will attempt to summarise the current evidence with a view to answer three practical questions: Which agents have been studied and how do they differ in how they influence clinical outcomes? When are they best administered and are they less or more beneficial if given earlier or later in evolving BPD? How can they be administered and is some route more efficient than the others in reducing the incidence of respiratory morbidity without increasing the incidence of severe neurodevelopmental impairment?