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Dexamethasone therapy increases infection in very low birth weight infants
B J Stoll1, M Temprosa, J E Tyson
1Emory University, Atlanta, Georgia 30335, USA. barbara_stoll@oz.ped.emory.edu
Insights
Dexamethasone treatment in preterm infants increased the risk of bloodstream and cerebrospinal fluid infections. Physicians should weigh this infection risk against potential benefits when treating very low birth weight infants.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Infections pose significant risks to preterm infants, increasing morbidity and mortality.
- Previous trials indicated dexamethasone may increase nosocomial bacteremia in very low birth weight (VLBW) infants.
- This study analyzes bacteremia/sepsis and meningitis in VLBW infants from a dexamethasone trial.
Purpose of the Study:
- To conduct an in-depth analysis of bacteremia/sepsis and meningitis in very low birth weight infants enrolled in a dexamethasone trial.
- To evaluate the impact of dexamethasone on the incidence of bloodstream and cerebrospinal fluid infections in VLBW infants.
Main Methods:
- Prospective data collection on cultures and antibiotic therapy.
- Classification of infections as definite or possible/clinical.
- Analysis of 371 very low birth weight infants receiving either dexamethasone or placebo for the first 14 days.
Main Results:
- Infants receiving dexamethasone showed a significantly higher rate of positive blood cultures (48% vs. 30%) and definite infections (22% vs. 14%) during the initial 14 days.
- Over the 6-week study, 29% of infants on dexamethasone experienced definite infections compared to 21% on placebo.
- Gram-positive organisms were the most common cause of definite infections (46.8%), followed by Gram-negative organisms and fungi (26.6% each).
Conclusions:
- A 14-day course of dexamethasone initiated at 2 weeks of age increases the likelihood of bloodstream or cerebrospinal fluid infections in VLBW infants.
- Physicians must consider the heightened risk of infection when prescribing dexamethasone for VLBW infants.
- The findings underscore the importance of risk-benefit assessment in neonatal steroid therapy.
Background:
Infection is a major complication of preterm infants, resulting in increased morbidity and mortality. We recently reported the results of a multicenter trial of dexamethasone initiated at 14 or 28 days in very low birth weight (VLBW) infants who were at risk for chronic lung disease; the results showed an increase in nosocomial bacteremia in the group receiving dexamethasone. This study is an in-depth analysis of bacteremia/sepsis and meningitis among infants enrolled in the trial.
Methods:
Data on cultures performed and antibiotic therapy were collected prospectively. Infections were classified as definite or possible/clinical.
Results:
A total of 371 infants were enrolled in the trial. There were no baseline differences in risk factors for infection. For the first 14 days of study, infants received either dexamethasone (group I, 182) or placebo (group II, 189). During this period, infants in group I were significantly more likely than those in group II to have a positive blood culture result (48% vs 30%) and definite bacteremia/sepsis/meningitis (22% vs 14%). Over the 6-week study period, 47% of those cultured had at least one positive blood culture result (53% in group I vs 41% in group II) and 25% of the infants had at least one episode of definite bacteremia/sepsis/meningitis (29% in group I vs 21% in group II). Among infants with definite infections, 46.8% were attributable to Gram-positive organisms, 26.6% to Gram-negative organisms and 26.6% to fungi. The factors present at randomization were evaluated for their association with infection. Group I assignment and H(2) blocker therapy (before study entry) were associated with increased risk of definite infection, whereas cesarean section delivery and increasing birth weight were associated with decreased risk.
Conclusions:
Infants who received a 14-day course of dexamethasone initiated at 2 weeks of age were more likely to develop a bloodstream or cerebrospinal fluid infection while on dexamethasone therapy than were those who received placebo. Physicians must consider this increased risk of infection when deciding whether to treat VLBW infants with dexamethasone.