Abstract
Objective: To assess the effect of moderately early postnatal dexamethasone treatment on growth and neurodevelopmental outcome in preterm infants.
Methods: Thirty preterm infants enrolled in a randomised clinical trial to investigate the effectiveness of moderately early dexamethasone administration in the treatment of chronic lung disease were routinely followed up. Fifteen babies received a total dose of 4.75 mg/kg over 14 days from the 10th day of life, and 15 babies were untreated. Five infants in each group received open label steroids to facilitate extubation later in their clinical course. Growth and neurodevelopmental outcome are reported.
Results: The mean body weight, height, and head circumference as well as the number of babies with anthropometric measurements within normal range were similar in treated and untreated babies. There was no significant difference between treated and control groups with respect to incidence of cerebral palsy, major neurosensory impairment, mean intelligence quotient scores, and behavioural abnormalities.
Conclusions: Postnatal dexamethasone treatment with the schedule used in this study did not impair growth and neurodevelopmental outcome in preterm infants. Data from larger trials have raised major concern that postnatal steroid treatment may increase neurodevelopmental impairment. The full extent of the risk will only be known when more trials have reported follow up data.
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Selected References
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- Barrington K. J. Postnatal steroids and neurodevelopmental outcomes: a problem in the making. Pediatrics. 2001 Jun;107(6):1425–1426. doi: 10.1542/peds.107.6.1425. [DOI] [PubMed] [Google Scholar]
- Cummings J. J., D'Eugenio D. B., Gross S. J. A controlled trial of dexamethasone in preterm infants at high risk for bronchopulmonary dysplasia. N Engl J Med. 1989 Jun 8;320(23):1505–1510. doi: 10.1056/NEJM198906083202301. [DOI] [PubMed] [Google Scholar]
- Edwards H. E., Burnham W. M. The impact of corticosteroids on the developing animal. Pediatr Res. 2001 Oct;50(4):433–440. doi: 10.1203/00006450-200110000-00003. [DOI] [PubMed] [Google Scholar]
- Ferrara T. B., Couser R. J., Hoekstra R. E. Side effects and long-term follow-up of corticosteroid therapy in very low birthweight infants with bronchopulmonary dysplasia. J Perinatol. 1990 Jun;10(2):137–142. [PubMed] [Google Scholar]
- Jones R., Wincott E., Elbourne D., Grant A. Controlled trial of dexamethasone in neonatal chronic lung disease: a 3-year follow-up. Pediatrics. 1995 Nov;96(5 Pt 1):897–906. [PubMed] [Google Scholar]
- Mammel M. C., Fiterman C., Coleman M., Boros S. J. Short-term dexamethasone therapy for bronchopulmonary dysplasia: acute effects and 1-year follow-up. Dev Pharmacol Ther. 1987;10(1):1–11. doi: 10.1159/000457722. [DOI] [PubMed] [Google Scholar]
- Murphy B. P., Inder T. E., Huppi P. S., Warfield S., Zientara G. P., Kikinis R., Jolesz F. A., Volpe J. J. Impaired cerebral cortical gray matter growth after treatment with dexamethasone for neonatal chronic lung disease. Pediatrics. 2001 Feb;107(2):217–221. doi: 10.1542/peds.107.2.217. [DOI] [PubMed] [Google Scholar]
- O'Shea T. M., Kothadia J. M., Klinepeter K. L., Goldstein D. J., Jackson B. G., Weaver R. G., 3rd, Dillard R. G. Randomized placebo-controlled trial of a 42-day tapering course of dexamethasone to reduce the duration of ventilator dependency in very low birth weight infants: outcome of study participants at 1-year adjusted age. Pediatrics. 1999 Jul;104(1 Pt 1):15–21. doi: 10.1542/peds.104.1.15. [DOI] [PubMed] [Google Scholar]
- O'Shea T. M., Kothadia J. M., Klinepeter K. L., Goldstein D. J., Jackson B., Dillard R. G. Follow-up of preterm infants treated with dexamethasone for chronic lung disease. Am J Dis Child. 1993 Jun;147(6):658–661. doi: 10.1001/archpedi.1993.02160300064024. [DOI] [PubMed] [Google Scholar]
- Romagnoli C., Zecca E., Tortorolo L., Vento G., Tortorolo G. A scoring system to predict the evolution of respiratory distress syndrome into chronic lung disease in preterm infants. Intensive Care Med. 1998 May;24(5):476–480. doi: 10.1007/s001340050599. [DOI] [PubMed] [Google Scholar]
- Romagnoli C., Zecca E., Vento G., Maggio L., Papacci P., Tortorolo G. Effect on growth of two different dexamethasone courses for preterm infants at risk of chronic lung disease. A randomized trial. Pharmacology. 1999 Nov;59(5):266–274. doi: 10.1159/000028329. [DOI] [PubMed] [Google Scholar]
- Shinwell E. S., Karplus M., Reich D., Weintraub Z., Blazer S., Bader D., Yurman S., Dolfin T., Kogan A., Dollberg S. Early postnatal dexamethasone treatment and increased incidence of cerebral palsy. Arch Dis Child Fetal Neonatal Ed. 2000 Nov;83(3):F177–F181. doi: 10.1136/fn.83.3.F177. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stark A. R., Carlo W. A., Tyson J. E., Papile L. A., Wright L. L., Shankaran S., Donovan E. F., Oh W., Bauer C. R., Saha S. Adverse effects of early dexamethasone in extremely-low-birth-weight infants. National Institute of Child Health and Human Development Neonatal Research Network. N Engl J Med. 2001 Jan 11;344(2):95–101. doi: 10.1056/NEJM200101113440203. [DOI] [PubMed] [Google Scholar]
- Stewart A. L., Reynolds E. O., Hope P. L., Hamilton P. A., Baudin J., Costello A. M., Bradford B. C., Wyatt J. S. Probability of neurodevelopmental disorders estimated from ultrasound appearance of brains of very preterm infants. Dev Med Child Neurol. 1987 Feb;29(1):3–11. doi: 10.1111/j.1469-8749.1987.tb02101.x. [DOI] [PubMed] [Google Scholar]
- Zecca E., Papacci P., Maggio L., Gallini F., Elia S., De Rosa G., Romagnoli C. Cardiac adverse effects of early dexamethasone treatment in preterm infants: a randomized clinical trial. J Clin Pharmacol. 2001 Oct;41(10):1075–1081. doi: 10.1177/00912700122012670. [DOI] [PubMed] [Google Scholar]