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Published on: August 25, 2014
Postnatal betamethasone treatment in extremely preterm infants and risk of neurodevelopmental impairment: a cohort
Linn Löfberg1,2, Fredrik Serenius3, Lena Hellstrom-Westas3
1Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Insights
Postnatal betamethasone treatment in extremely preterm infants was linked to a higher risk of neurodevelopmental impairment (NDI) by age 6.5. This association persisted after adjusting for confounding factors, indicating potential long-term effects.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Pharmacology
Background:
- Postnatal corticosteroids, like betamethasone, are used to manage respiratory distress syndrome in extremely preterm infants.
- The long-term neurodevelopmental effects of such treatments require thorough investigation.
Purpose of the Study:
- To determine the association between postnatal betamethasone treatment and neurodevelopmental impairment (NDI) at 6.5 years of age in extremely preterm infants.
Main Methods:
- A prospective cohort study involving 428 extremely preterm infants (gestational age <27 weeks) born between 2004-2007.
- Neurodevelopmental assessment at 6.5 years included cognitive testing (WISC-IV), neurological examination, and medical record review.
- Infants were categorized into those treated with betamethasone (n=115) and those not treated (n=313).
Main Results:
- Moderate to severe NDI was significantly more prevalent in the betamethasone-treated group (49%) compared to the untreated group (26%) (p<0.001).
- Betamethasone-treated children exhibited poorer cognitive development, with lower mean WISC-IV scores (75 vs. 87, p<0.001).
- The increased risk of NDI was dose-dependent and remained significant after logistic regression and propensity score matching.
Conclusions:
- Postnatal betamethasone treatment in extremely preterm infants is associated with an increased risk of neurodevelopmental impairment at 6.5 years of age.
- These findings highlight the need for careful consideration of the risks and benefits of postnatal betamethasone therapy.
Objective:
To evaluate if postnatal treatment with betamethasone in extremely preterm infants was associated with neurodevelopmental impairment (NDI) at 6.5 years of age.
Design:
Prospective cohort study.
Setting:
Extremely Preterm Infants in Sweden Study (gestational age <27 weeks, born 2004-2007).
Patients:
428 children born extremely preterm were assessed at 6.5 years of age, 115 treated with betamethasone and 313 not treated.
Main Outcome Measures:
NDI at 6.5 years of age. Evaluation at 6.5 years included cognitive testing with the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), neurological examination and a medical record review.
Exposure:
Treatment with postnatal betamethasone.
Main Outcome:
Moderate to severe NDI at 6.5 years of age, defined as a composite including cerebral palsy, and/or impairment in cognition, hearing and vision.
Results:
Moderate to severe NDI was more prevalent in children treated with postnatal betamethasone (49% treated vs 26% not treated, p<0.001). Betamethasone-treated children had worse cognitive development with mean WISC-IV score of 75 (SD 13.7) vs 87 (SD 14.0, p<0.001). The effect was dose dependent: 1.35 mg/kg vs 1.0 mg/kg (p=0.01) in betamethasone-treated children with moderate to severe versus no or mild NDI, respectively. The differences remained after adjustment for potential confounders with logistic regression (adjusted OR (aOR) 1.80, 95% CI 1.14 to 3.21). The difference in NDI also remained after propensity score matching, with crude OR 2.82 (95% CI 1.42 to 5.61, p=0.003) and aOR 2.17 (95% CI 1.07 to 4.69, p=0.04).
Conclusion:
Postnatal treatment with betamethasone is associated with increased risk of NDI at 6.5 years.
