Antenatal Dexamethasone For Women at Risk af Preterm Birth and Intraventricular Haemorrhage: What is the Truth?

Administration of antenatal corticosteroids to pregnant women with imminent delivery of a newborn at 24 to 34 weeks of gestation represents one of the most important advances in perinatal medicine in the past 25 years1,2. A single course of antenatal steroid has been associated with a decrease in acute neonatal systemic morbidity and mortality after preterm birth reducing the risk of respiratory distress syndrome and intraventricular haemorrhage (IVH)2,3. We advance the hypothesis that prenatal dexamethasone exposure may not protect preterm infants against IVH down-regulating the expression of survivin that plays a key role in the protection of brain cells against insult-induced apoptosis. Research studies are needed to better define whether antenatal betamethasone may be the best alternative therapy for antenatal prevention of IVH and whether dexamethasone may sensitize immature brain to IVH involving dose timing and treatment regimen.