Randomized, Controlled Trial of Dexamethasone in Neonatal Chronic Lung Disease: 13- to 17-Year Follow-up Study: I. Neurologic, Psychological, and Educational Outcomes

Abstract

Information was obtained for 150 adolescents randomized to receive dexamethasone or placebo for neonatal chronic lung disease. Rates of disabilities and educational difficulties were high, but with no significant differences between the 2 groups. Some use of open-label steroids in the placebo group plus losses to long-term follow-up monitoring reduced the power of this study to detect clinically important differences, and this study cannot rule out a real increase in cerebral palsy, as reported by others.

Randomized, Controlled Trial of Dexamethasone in Neonatal Chronic Lung Disease: 13- to 17-Year Follow-up Study: II. Respiratory Status, Growth, and Blood Pressure

“…There was no evidence of any differences between the children included in the follow-up study and those not included, in particular with regard to open-label steroid usage. 21 Results of lung-function testing are shown in Table 1. Although the majority of children had lung function falling within the normal range, z scores showed that both groups of children had results below those expected for age and height, but with no difference between the 2 groups.…”

“…The mean head circumference in adolescence was ϳ1 SD below expected, and this finding is reflected in the higher levels of neurodisability among these children. 21 However, no differences in any growth pa- Details of participants in spirometry study. *Twelve children did not complete postbronchodilator spirometry; for 4, parental consent for salbutamol was refused; for 5, parental consent for salbutamol was given, but the child refused; for 3, postsalbutamol spirometry was attempted, but results were unsatisfactory.…”

“…Survivors were evaluated at 3 years of age. 14 Children from the 25 British and Irish centers were traced for reassessment at 13 to 17 years of age 21 and were contacted through their general practitioners (GPs). Assessments were conducted in the children's own homes between 2001 and 2002; study nurses and families remained blinded to the original treatment allocation.…”

The origins of cerebral palsy

“…Absence of antenatal steroids, growth restriction, and adverse events in the newborn period such as prolonged hypocarbia and postnatal steroids assume greater importance. A recent study from the UK [27 ] was unable to confirm the increase in CP associated with postnatal steroids.…”

Long-term cardiovascular effects of neonatal dexamethasone treatment: hemodynamic follow-up by left ventricular pressure-volume loops in rats

“…The American Academy of Pediatrics and the Canadian Pediatric Society recently published guidelines for the use of postnatal steroid treatment in preterm infants (1). With regard to the long-term effects on the brain, studies have documented adverse outcomes, including cerebral palsy and delayed and abnormal neurological development (5,6,12,18,41). The short-term cardiovascular effects after neonatal dexamethasone treatment include hypertension and hypertrophic cardiomyopathy.…”