Long-term effects of antenatal administration of corticosteroids. Where are we?
Efectos a largo plazo de la administración antenatal de corticosteroides. ¿Dónde estamos?
Resumen
Basándose en estudios en animales y observacionales en huma- nos, recientemente se han planteado una serie de dudas sobre los efectos a largo plazo de la administración antenatal de corticosteroides y se han notificado algunas complicaciones en neonatos, adolescentes y adultos; que incluso, podrían transmitirse a generaciones posteriores. Extenderla al periodo prematuro tardío, podría conducir a un aumento drástico del número de recién nacidos expuestos in útero. En esta revisión se resume el conocimiento actual de los efectos a largo plazo de la administración antenatal de corticosteroides y se aportan datos para la elaboración de guías para su uso. Para la metodología se realizó una búsqueda bibliográfica en la base de datos PubMed. Se ha propuesto un mecanismo para explicar cómo la administración antenatal de corticosteroides puede causar morbilidad en el neurodesarrollo neonatal y enfermedades programadas del adulto. Sin embargo, esta teoría no se ha demostrado en grandes pruebas controladas aleatorizadas. Aquí resumimos los efectos, a favor y en contra, a largo plazo de la administración antenatal de corticosteroides. La evidencia actual es inconsistente, los estudios de seguimiento de los ensayos controlados aleatorizados no han encontrado un mayor riesgo de deterioro neurológico en los niños, después de un solo curso antenatal de corticosteroides. Los ensayos observacionales y clínicos no muestran pruebas de aumento de discapacidad y describen asociaciones más que causas. Antes de las 34 semanas de embarazo, la administración antenatal de corticosteroides en mujeres con alto riesgo de parto pretérmino, parece mejorar la mayoría de resultados del neurodesarrollo. Antes del parto pretérmino, se recomienda un curso simple de tratamiento con corticosteroides.
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