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Effect of cumulative dexamethasone dose in preterm infants on neurodevelopmental and growth outcomes: a Western
Ashok Kumar Buchiboyina1, Chi Seong Andrew Yip2, Rolland Kohan3,4
1Department of Neonatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia ashok.buchiboyina@health.wa.gov.au.
Insights
Dexamethasone exposure in preterm infants did not increase long-term disability. However, higher dexamethasone doses were linked to reduced growth measurements, including weight, height, and head circumference, compared to controls.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Pharmacology
Background:
- Corticosteroids like dexamethasone are used to manage respiratory distress in preterm infants.
- The long-term neurodevelopmental and growth effects of cumulative dexamethasone exposure require further investigation.
Purpose of the Study:
- To compare neurodevelopmental and growth outcomes based on cumulative dexamethasone exposure in preterm infants.
- To assess the association between varying dexamethasone doses and long-term disability and growth parameters.
Main Methods:
- Retrospective cohort study of preterm infants (<29 weeks gestation) mechanically ventilated for >7 days.
- Infants were categorized into no dexamethasone (controls), lower cumulative dose (<2 mg/kg), and higher cumulative dose (≥2 mg/kg).
- Long-term disability was assessed at 2 and 5 years; growth was measured at 2 years.
Main Results:
- No significant difference in long-term disability or cerebral palsy was observed between infants receiving dexamethasone and controls.
- Infants in the higher dexamethasone dose group showed significantly lower mean z-scores for weight, height, and head circumference compared to controls.
- No significant difference in disability was found between lower and higher dexamethasone dose groups.
Conclusions:
- Dexamethasone use in this cohort of preterm infants was not associated with an increased risk of long-term disability.
- Cumulative dexamethasone exposure, particularly higher doses, was associated with impaired growth outcomes in preterm infants.
Objective:
Comparing the long-term neurodevelopmental and growth outcomes of lower and higher cumulative dexamethasone exposure in preterm infants ventilated for a minimum cumulative duration of 7 days.
Design:
A retrospective cohort medical chart review of infants born in Western Australia <29 weeks' gestation between January 2007 and May 2016 who were mechanically ventilated >7 days.
Intervention:
No dexamethasone (controls) or a total cumulative dexamethasone dose of <2 mg/kg (lower) and ≥2 mg/kg (higher).
Main Outcome Measures:
Long-term disability at 2 and 5 years and growth measurement outcomes at 2 years of age.
Results:
Dexamethasone was given to 104 infants (66 with cumulative dose <2 mg/kg; 38 with cumulative dose ≥2 mg/kg), and 324 infants were controls. There was no difference in odds of long-term disability in infants with any dexamethasone exposure compared with controls (aOR: 0.90, 95% CI 0.34 to 2.02, p=0.784). No difference in long-term disability was found between the lower and higher groups (p=0.494). The prevalence of cerebral palsy (Gross Motor Functional Classification System level ≥2) between the control, lower and high-dose groups did not differ significantly (5.8% vs 4.0% vs 0%). The higher dose group had lower mean weight z-score (mean effect: -0.83, 95% CI: -1.54 to -0.01, p=0.023), height z-score (mean effect: -0.63, 95% CI: -12.5 to -0.01, p=0.048) and head circumference z-score (mean effect: -0.65, 95% CI: -1.25 to -0.05, p=0.035) compared with controls.
Conclusions:
In our cohort, dexamethasone use was not associated with increased odds of long-term disability. Dexamethasone use was associated with lower growth measurements compared with controls.
