Premature babies could benefit from combined glucocorticoid, antioxidant therapy: Study

As part of a recent study, scientists have suggested that subtle changes to the drugs administered to mothers threatened with preterm birth or to premature babies could further improve clinical treatment and help increase their safety.

While the current practice of using glucocorticoid therapy shows life-saving benefits for the preterm infant, the researchers say that combining them with antioxidants would overcome potential safety concerns associated with existing treatment.

One in ten babies is born prematurely and up to three-quarters of these are at significant risk of death or long-term illness because premature babies are born with immature lungs and hence are at risk of dying from respiratory problems.

The clinical use of glucocorticoids both in mothers at risk of premature labor and in premature babies has become common practice in the last 40 years. The treatment is based on research which discovered the important role played by glucocorticoids in fetal development and that giving premature babies synthetic glucocorticoids could accelerate the development of their lungs and respiratory system.

Now, every mother at risk of preterm birth gets this treatment worldwide in developed societies. It is regarded as one of the best examples of successfully translating basic experimental science into efficient human clinical practice and it has saved millions of preterm children every year.

However, despite the very clear life-saving effects of antenatal and postnatal glucocorticoid therapy to accelerate lung maturation in the infant, new research has identified some potential adverse side effects on the offspring's growth, central nervous and cardiovascular systems. Some of these effects will not be seen until the child is fully grown and is in adulthood.

"The evidence supporting the life-saving benefits of glucocorticoid treatment for premature babies is overwhelming. Without it, preterm babies would mostly die or suffer significantly from conditions associated with prematurity, leaving them with significant disability," said Professor Dino Giussani, lead researcher of the study.

"Unfortunately, there can be subtle adverse effects from the therapy that suggest we need to fine-tune current clinical therapy to maintain its beneficial effects but weed out any potential negative adverse effects later in life," said Giussani.

In a review published online in the journal Trends in Endocrinology and Metabolism, the team of researchers propose that in future, combined therapy of glucocorticoids with specific antioxidants may be safer for the treatment of the premature baby.

Professor Giussani and Ms Garrud point to research that suggests one likely culprit mechanism is the capacity of synthetic glucocorticoids to induce what is so-called 'oxidative stress', caused by an imbalance in the body of unstable atoms known as free radicals. While the body needs a certain number of free radicals for cell signaling or to stimulate repair, an overabundance can cause damage. Oxidative stress has been shown to lead to restricted blood flow and can damage the cardiovascular system in the long-term.

"When we bring together the research out there on this issue, we find strong evidence to suggest that combined antioxidant and glucocorticoid therapy may be safer than glucocorticoid therapy alone for the treatment of preterm birth," says Garrud.