A three year follow up of preterm infants after moderately early treatment with dexamethasone

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. P ostnatal dexamethasone has been widely used in the treatment of chronic lung disease (CLD) in preterm infants, and several randomised trials have shown that it rapidly reduces requirements for oxygen and ventilation. However, the long term consequences on mortality and morbidity are less clear, and recent reports have raised concerns that postnatal steroids may cause neurodevelopmental impairment in preterm infants. [1][2][3] In animal models, corticosteroids significantly impair cell multiplication in the central nervous system and lung. 4 Murphy et al, 5 using advanced magnetic resonance imaging techniques, documented a reduction in the volume of cortical grey matter in preterm infants exposed to postnatal dexamethasone treatment, and this finding is consistent with clinical trials reporting a reduction in head growth and an increase in the rates of cerebral palsy among children who received steroids as compared with controls. The recent systematic review performed by Barrington,6 which included eight randomised controlled trials enrolling 679 infants, showed a relative risk for neurodevelopmental impairment among surviving, followed up, treated infants of 1.34 (95% confidence interval (CI) 1.09 to 1.64) and a relative risk for cerebral palsy of 2.02 (95% CI 1.51 to 2.71).In this study we describe the follow up findings at three years of adjusted age for 30 surviving infants at high risk for CLD who participated in a randomised clinical trial on the moderately early postnatal use of dexamethasone. MATERIALS AND METHODSThe original randomised clinical trial was carried out in our neonatal intensiv...

Catch-up growth after dexamethasone withdrawal occurs in cultured postnatal rat metatarsal bones

“…In some studies, treatment of premature infants with Dexa was associated with decreased longitudinal growth (Wood et al 2003, Rijken et al 2007, but this was not confirmed by others (Halliday 2001, Romagnoli et al 2002. Interestingly, premature infants with a relative insensitivity to glucocorticoids, exhibit a complete catch-up growth during the first 2 years of life while infants without this polymorphism remain below the mean height for the normal population up to 19 years of age (Finken et al 2007).…”

Growth of Preterm Born Children

“…In approximately 10% of them length remains below the –2 SDS line [65]. Most studies have shown that postnatal corticosteroid treatment has a negative effect on postnatal catch-up [64, 82, 83], but others did not find such effect [61,84,85,86]. Other factors that have been negatively related to later (catch-up) growth in preterm infants include male gender [3], medical complications [87] and being born SGA [60,61,62,63, 88].…”

Assessment of Skeletal Development in Preterm and Term Infants by Quantitative Ultrasound

“…The study was approved by the Institutional Review Board and parents' informed consent was obtained. The following exclusion criteria were adopted: intrauterine growth retardation (birth weight ϽϪ2 SD), congenital metabolic disorders, chromosomal imbalance syndromes, congenital infection syndromes, rickets (maternal osteomalacia), maldigestion, malabsorption, neuromuscular disorders, renal or endocrinological diseases, or dexamethasone treatment (17,18). Length and weight were measured at the time of assessment.…”