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Follow-up of a randomized, placebo-controlled trial of dexamethasone to decrease the duration of ventilator

T Michael O'Shea1, Lisa K Washburn, Patricia A Nixon

  • 1Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. moshea@wfubmc.edu

Pediatrics
|September 4, 2007
PubMed

Insights

Dexamethasone in premature infants reduced chronic lung disease but showed higher rates of major neurodevelopmental impairments, including cerebral palsy, in long-term follow-up. However, the composite outcome of death or impairment was not significantly increased.

Area of Science:

  • Neonatal medicine
  • Pediatric neurology
  • Developmental pediatrics

Background:

  • High-dose dexamethasone use in premature infants is linked to reduced chronic lung disease.
  • Concerns exist regarding potential developmental impairments associated with neonatal dexamethasone exposure.

Purpose of the Study:

  • To evaluate long-term developmental outcomes in children exposed to dexamethasone as neonates.
  • To compare neurodevelopmental impairments beyond infancy between dexamethasone and placebo groups.

Main Methods:

  • A randomized trial assigned very low birth weight infants to a 42-day dexamethasone course or placebo.
  • Survivors were assessed for major neurodevelopmental impairment (cerebral palsy, cognitive impairment, blindness) at 1 year and 4-11 years of age.

Main Results:

  • Major neurodevelopmental impairments occurred in 40% of the dexamethasone group versus 20% in the placebo group, primarily due to increased cerebral palsy.
  • The composite outcome of death or major neurodevelopmental impairment was 47% for dexamethasone and 41% for placebo.

Conclusions:

  • A 42-day tapering course of dexamethasone does not increase the risk of the composite outcome of death or major neurodevelopmental impairment in very low birth weight infants.
  • While dexamethasone use was associated with higher rates of specific impairments like cerebral palsy, the overall composite outcome was not significantly elevated in long-term follow-up.
Abstract

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