Repeated prenatal corticosteroids delay myelination in the ovine central nervous system

Maternal administration of corticosteroids is used to promote lung maturation in human infants considered at risk of preterm delivery [1]. Randomised trials of a single course of corticosteroid treatment have indicated no adverse long-term neurological or cognitive sequelae [2-5]. However, the current trend in many obstetric centres is to use repeated courses in cases where preterm birth has not eventuated, but the risk persists 7 days beyond administration of the original course [6-7]. This practice has not yet been subject to randomised trials of outcome. We have examined the effect of repeated injections of corticosteroids on the development of the optic nerve in prenatal fetal sheep and report a significant delay in the myelination of optic axons. Our results, together with those from other animal studies [8], show that repeated courses of corticosteroids may be detrimental to central nervous system (CNS) development. Clinical practice should balance the known beneficial effects on lung maturation of a single course of corticosteroid against the potential damage to the CNS of repeated courses.