Delayed Dexamethasone Therapy and Neurodevelopmental Outcomes in Preterm Infants with Bronchopulmonary Dysplasia

It remains unclear whether the benefit of postnatal corticosteroid as a respiratory rescue therapy outweighs the potential harm of neurodevelopmental impairment (NDI) in very-low-birth-weight infants at risk of bronchopulmonary dysplasia (BPD).

We reviewed the charts of very-low-birth-weight infants with oxygen dependency for 28 days or more and who survived until 18-22 months' corrected age. Patients were divided into the delayed (≥21 days after birth) dexamethasone therapy (DDT, n=71) and the control (n=60) groups. NDI was defined by the presence of cerebral palsy, Bayley Mental or Psychomotor Developmental Index less than 70, deafness, or blindness.

The DDT group was more premature and had worse respiratory morbidities before (ventilator-dependent at 21 days, 69% vs. 17%) and after the DDT (moderate/severe BPD, 41% vs. 15%) than the control group. The risk of NDI did not differ between the DDT and the control groups in the entire cohort (odds ratio and 95% confidence interval, 1.309 [0.530-3.237]) or in the propensity-score-matched cohort (n=62; odds ratio and 95% confidence interval, 1.344 [0.455-3.976]). However, in the subgroup of infants exposed to DDT, the cumulative dexamethasone dose greater than 5.0 mg/kg was significantly associated with NDI.

Among the very-low-birth-weight infants with BPD, there was no definitely harmful effect of DDT on the neurodevelopmental outcome in the short term. However, considering the potential harm of high cumulative doses of dexamethasone on the developing brain, further studies are needed to determine the optimal dosage of DDT to be administered for the prevention of BPD.