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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Functional outcome at school age of preterm-born children treated with high-dose dexamethasone
Marrit M Hitzert1, Koenraad N J A Van Braeckel1, Marijn de Bok1
1Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Insights
High-dose postnatal dexamethasone (DXM) treatment in preterm infants is linked to poorer school-age outcomes in motor, cognitive, and behavioral domains. Specific DXM-related risk factors exacerbate these adverse effects.
Area of Science:
- Neonatal care
- Pediatric neurology
- Developmental pediatrics
Background:
- Postnatal dexamethasone (DXM) is used for pulmonary issues in preterm infants.
- DXM is associated with adverse motor outcomes.
- The long-term functional impact at school age remains unclear.
Purpose of the Study:
- To assess school-age motor, cognitive, and behavioral outcomes in preterm children receiving high-dose DXM.
- To identify DXM-related risk factors for adverse outcomes.
Main Methods:
- A cohort study included 53 very preterm infants treated with DXM (0.5mg/kg/d).
- Neuropsychological assessments were conducted at a median age of 9 years.
Main Results:
- DXM-treated children showed significantly worse scores compared to the norm population on the Movement-ABC (fine motor, ball skills, balance).
- A higher proportion of DXM-treated children had total, verbal, and performance IQs below 85.
- Adverse outcomes were more pronounced with increasing DXM-related risk factors.
Conclusions:
- High-dose DXM treatment in preterm children negatively affects multiple functional domains by school age.
- DXM-related risk factors are critical considerations for predicting adverse outcomes.
Background:
Postnatal dexamethasone (DXM) treatment is associated with adverse motor outcome. It is largely unknown as to what extent functional outcome at school age is affected.
Aims:
Our first aim was to determine motor, cognitive, and behavioural outcome at school age of preterm-born children treated with high-dose DXM for pulmonary problems. Our second aim was to identify DXM-related risk factors for adverse outcome.
Study Design:
In this cohort study, we included 53 very preterm-born children treated with DXM (starting dose 0.5mg/kg/d) after the first week of life. At the median age of 9 years, we performed a detailed neuropsychological assessment.
Results:
Compared to the norm population, DXM-treated children scored worse on the Movement-ABC (abnormal fine motor, ball skills and balance: 59%, 47% and 30%, respectively). They more often had total (36%), verbal (32%) and performance IQs (55%) below 85 (P<.001, P=.002, P<.001, respectively). On each of the remaining measures, DXM-treated children scored worse than the norm population, except for verbal long-term memory and verbal recognition memory. DXM-related risk factors were associated with poorer performance.
Conclusions:
At school age, multiple domains of functional outcome were affected in DXM-treated children. Risk factors related to the use of DXM should be considered as serious potentiaters of adverse outcome in children treated with high-dose DXM.
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