Steroid Use in the NICU: Treatment and Tapering

The adrenal gland cortex produces life-sustaining steroid hormones that are critical for the development and survival of the fetus and neonate. Antenatal and postnatal administration of steroids has critical therapeutic effects in preterm infants. However, prolonged postnatal steroid therapy for more than 1 to 2 weeks is associated with iatrogenic adrenal insufficiency and should prompt consideration of a steroid taper and stress dose precautions. In this review, we will describe fetal adrenal development and steroidogenesis, the effect of antenatal exogenous steroids, the therapeutic role of postnatal steroids, evaluation and treatment of adrenal insufficiency, and the role of steroid tapers after prolonged steroid treatment.