Systematic review and meta-analysis of early postnatal dexamethasone for prevention of chronic lung disease

Abstract

Aim-To review systematically the evidence to determine whether dexamethasone treatment of very low birthweight infants begun within 14 days of age prevents chronic lung disease (CLD) without clinically significant side eVects. Methods-Randomised controlled trials of dexamethasone started within this time frame were identified through a search of electronic databases, proceedings of scientific meetings, and personal files. Metaanalyses using event rate ratio (ERR), event rate diVerence (ERD), and if significant, numbers needed to treat (NNT) for benefits and numbers needed to harm (NNH) for adverse eVects were calculated. Weighted mean diVerence were used for continuous variables. Three prespecified subgroup analyses were performed for; (i) dexamethasone begun within 36 hours (hours) of birth; (ii) dexamethasone initiated between 7-14 days of age; or (iii) if surfactant treatment was used. Results-Ten studies were included in the review; six where dexamethasone was initiated within 36 hours of age, four studies for dexamethasone started between 7 and 14 days and six studies using surfactant. Mortality ERR and NNT with 95% confidence intervals for dexamethasone initiated at 7-14 days of age were 0.35 (0.16, 0.74) and 8 (4, 30). ERRs and NNTs for CLD at 28 days and 36 weeks of postmenstrual age were 0.71 (0.61, 0.84), 8 (5, 17), and 0.57 (0.44, 0.76), 10 (6, 23) in the overall analyses. When dexamethasone was started at 7 to 14 days of age ERR and NNT for CLD at 36 weeks were 0.63 (0.47, 0.85) and 3 (2, 9). Clinically significant side eVects included increased risk of hypertension, hyperglycaemia, and increased time to regain birthweight. Conclusions-These meta-analyses show a significant reduction in risk of CLD at 28 days and 36 weeks of postmenstrual age. In the subgroup where dexamethasone was started between 7 and 14 days of age mortality was significantly reduced. Caution is warranted in the routine use of dexamethasone because of lack of data on long term neurodevelopmental outcomes.

Prospective Evaluation of Postnatal Steroid Administration: A 1-Year Experience From the California Perinatal Quality Care Collaborative

“…5,6 Metaanalyses of early (Ͻ96 hours of age) 7 and later use of PNSs to reduce CLD 8,9 demonstrated significant benefits with regard to earlier extubation and decreased risks of CLD at both 28 days and 36 weeks, death, or CLD at 28 days and 36 weeks, but there was a disturbing tendency toward an increase in neurodevelopmental impairment consistent with previous animal experiments, which had shown that glucocorticoids administered during critical periods of brain development may impair myelinization, brain cell division, and longer-term behavioral effects. [10][11][12][13][14][15][16] The American Academy of Pediatrics Committee on the Fetus and Newborn cautioned that PNS use outside of randomized trials should be reserved for "exceptional clinical circumstances."…”

Cecal Colonization and Systemic Spread of Candida albicans in Mice Treated with Antibiotics and Dexamethasone

“…In the past decade, there has been a significant increase in the use of glucocorticoids (particularly i.v. dexamethasone) in the NICU (17,18), and this practice is coincident with the increase in C. albicans infections (7,19). Although dramatic physiologic improvement in pulmonary function can been seen almost immediately with the use of steroids in premature infants, both short-term and long-term adverse affects, including increased risk of infection, are now being documented [(20), also reviewed by Jobe (21)].…”

Effects of Corticosteroids in Very Low Birth Weight Newborns Dependent on Mechanical Ventilation

“…Over the past decades, methods have differed as to the beginning of administration of corticosteroids: (i) from the first hours of life (early), 6,[7][8][9]16,[45][46][47] (ii) from 7 to 14 days of life (moderately early), 12,23,48 (iii) after 14 days of life (late) 10,13,49,50 . Doses and the length of treatment (from 9 to 42 days) are also reported.…”