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Updated: Jul 18, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Systematic review of the long-term effects of postnatal corticosteroids
Allan C Jenkinson1, Ourania Kaltsogianni1, Theodore Dassios1,2
1Department of Women and Children, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Insights
Dexamethasone given to preterm infants may harm lung and cognitive development long-term. Further research is needed to find safer alternatives for bronchopulmonary dysplasia treatment.
Area of Science:
- Neonatal medicine
- Pediatric pulmonology
- Developmental neuroscience
Background:
- Dexamethasone is used in neonatal intensive care to reduce bronchopulmonary dysplasia.
- Long-term adverse effects of early dexamethasone exposure require investigation.
Approach:
- Systematic review of 18 observational studies (1,609 patients) identified from electronic databases and grey literature.
- Assessed respiratory (spirometry), cardiovascular (blood pressure, echocardiography), and cognitive/motor outcomes.
Key Points:
- Dexamethasone exposure linked to poorer pulmonary function (abnormal FVC, FEV1:FVC z scores) in children and adolescents.
- Cognitive deficits observed: lower IQ scores compared to preterm and term controls.
Conclusions:
- Postnatal dexamethasone negatively impacts childhood and adolescent pulmonary and cognitive development.
- Need for alternative medications with improved benefit-risk profiles is critical.
Background:
Dexamethasone administration can reduce bronchopulmonary dysplasia, our objective was to identify long term adverse effects.
Content:
A systematic review was performed to determine the childhood and adolescent cardiopulmonary and cognitive effects of dexamethasone systemically administered to preterm infants during neonatal intensive care. Relevant studies were identified by searching two electronic health databases and the grey literature. Spirometry assessments were used as respiratory outcomes, blood pressure and echocardiography assessments as cardiovascular outcomes and cognitive and motor function as cognitive outcomes. From 1,479 articles initially identified, 18 studies (overall 1,609 patients) were included (respiratory n=8, cardiovascular n=2, cognitive n=10); all were observational cohort studies. Dexamethasone exposure was associated with worse pulmonary outcomes in children and adolescents (more abnormal FVC and FEV1:FVC z scores). Dexamethasone exposure was associated in one study with lower IQ scores compared to preterm controls (mean 78.2 [SD 15.0] vs. 84.4 [12.6], [p=0.008]) and in two others was associated with lower total and performance IQ when compared to term controls (p<0.001).
Summary And Outlook:
Postnatal dexamethasone exposure has a negative influence on pulmonary and cognitive outcomes in childhood and adolescence. Medications with a better benefit to risk profile need to be identified.
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