ESPE Abstracts

Context: Supra-physiological exogenous corticosteroids used during the last months of pregnancy may lead to temporary neonatal adrenal suppression. Little is known about the outcome of neonates from mothers who used corticosteroids during pregnancy.

Objective: The evaluation of clinical symptoms and biochemical findings of adrenal suppression in neonates from mothers using corticosteroids during pregnancy.

Methods: We retrospectively investigated files from neonates of mothers who used corticosteroids for at least the last three weeks of the third trimester between 2010-2016. In the first days after birth, random serum cortisol levels were determined in neonates of 29-41 weeks of gestational age. If cortisol levels were <550 nmol/l, ACTH-stimulated cortisol levels were measured within 4 weeks after birth. Adrenal suppression was defined as maximum cortisol <550 nmol/l after ACTH stimulation.

Results: Neonates (n=106) had a median gestational age of 38 weeks (IQR 36-39 weeks) and a median birthweight of 2963 gram (IQR 2400-3331 gram). The majority of the mothers used prednisone (n=96), the median dose of prednisone was 18 mg/day (IQR 7.5-30 mg). We found no clinical signs of adrenal suppression nor Addisonian crises in the neonates. Seventy-nine % of the available highest cortisol levels of the neonates was < 550 ; 55% < 300; 37% < 200 nmol/l. There was no association between low random cortisol levels and hypoglycemia. Furthermore, the outcome of a ACTH stimulation test was normal in the vast majority of the group who underwent the test.

Conclusion: This is the first study in a large group of neonates after maternal corticosteroid use during pregnancy. No clinical adrenal problems were seen. In addition, random serum cortisol levels in these neonates do not seem to identify the cases that will have a higher chance of an Addisonian crisis. We propose a protocol in which no standard serum cortisol levels will be measured after birth, but in which parents are educated when and how to seek help in the very small chance of Addisonian crisis in the first months after birth.