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Best Laid Plans: Antenatal Corticosteroid Administration and Retinopathy of Prematurity

Title of Article: Beyond Fetal Immunity: A Systematic Review and Meta-Analysis of the Association Between Antenatal Corticosteroids and Retinopathy of Prematurity

What are the key takeaway points from this article?

Retinopathy of prematurity (ROP) is a disorder of the retina which leads to abnormal retinal vasculature development and an important cause of blindness in preterm infants. Antenatal steroids (ACS) have been shown to reduce neonatal morbidities such as respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH) and neonatal death. Given that prenatal inflammatory factors play a role in ROP development and progression, the role of ACS in ROP development and progression is an important association to examine. The authors of this systematic review and meta-analysis sought to provide an updated review of the literature to determine the association between ACS exposure and the development of ROP in premature infants. The inclusion criteria included studies containing a control group of ACS-exposed preterm infants and their reported ROP rates.  

Amongst 63 included studies of 196,264 infants, the meta-analysis demonstrated that ACS exposure was not associated with ROP occurrence and importantly, a significant reduced risk of ROP occurrence. There are theories regarding the protective effect of ACS on ROP, with one theory being that since ACS reduces the risk of RDS (a high oxygen demand disease), this may mitigate the risk factor of RDS for the development of ROP. ACS exposed infants also had significantly lower odds of ROP progression. Conversely, the authors found birth weight and patent ductus arteriosus were associated with ROP occurrence within this sample.   

The authors concluded that ACS exposure is associated with a decrease but not prevention of the progression to severe ROP. However, acknowledging that their analysis was limited to studies that are observational rather than RCTs, invites caution when interpreting these results. Future studies are needed to assess causality between variables beyond the correlational nature of this analysis.  Despite these limitations, the authors did conclude recommending routine use of ACS in those at risk of extreme preterm birth, to prevent the severity and progression of ROP. 

Publication Date: January 2022


Zeng, Y., Ge, G., Lei, C., & Zhang, M. (2022). Beyond Fetal Immunity: A Systematic Review and Meta-Analysis of the Association Between Antenatal Corticosteroids and Retinopathy of Prematurity. Frontiers in pharmacology13, 759742.

Summary By: Natalie Mezey


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