Preterm Infants and Effects of Antenatal Steroids

Dr. Elizabeth V. Asztalos, MD, M.Sc., FRCPC Sunnybrook Health Sciences Centre 2075 Bayview Ave., Room M4 230 Toronto, ON M4N Interview with:
Dr. Elizabeth V. Asztalos, MD, M.Sc., FRCPC
Sunnybrook Health Sciences Centre
2075 Bayview Ave., Room M4 230
Toronto, ON M4N 3M5 What are the main findings of the study?

Answer: This study was focused to see if there were differences in the main neurodevelopmental outcomes of children whose mothers had participated in the original MACS trial. We found that there were no differences in the main outcomes of the trial as it related to the aspects of death and/or developmental. Were any of the findings unexpected?

Answer: The main findings were not unexpected since we were not seeing benefits all the way along with our ongoing follow-up throughout the past 10 years since the original MACS trial had started. What should clinicians and patients take away from your report?

Answer: Multiple antenatal corticosteroids are often used with the hopes of improving respiratory management for the preterm infant. The original MACS trial showed that even though there was some marginal improvement in respiratory management, it did not translate into a reduction in the major neonatal morbidities often associated with long-term outcome. We saw that in our two-year follow-up. This continued onwards to 5 years of age. Because there is still unknown knowledge about the long-term effects of steroids as it relates to its contribution to long-term health, and knowing that there is no benefit seen, then the current practice of single course of antenatal corticosteroids given when a women is at risk of preterm labor should be encouraged only. Additional courses should only be considered with the patient knowing that it is not seen as reducing the major neonatal morbidities and improving long-term outcome. What recommendations do you have for future research as a result of this study?

Answer: It would be of great interest to be able to continue to follow this study population to see any long-term effects of exposure to antenatal corticosteroids on general health and its potential contribution or not to illness and wellness.


Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study Outcomes in Children at 5 Years of Age (MACS-5)
JAMA Pediatr. Published online October 14, 2013.


Last Updated on October 16, 2013 by Marie Benz MD FAAD