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Severe retinopathy of prematurity in extremely low birth weight infants after short-term dexamethasone therapy
R Ramanathan1, B Siassi, R A deLemos
1Department of Pediatrics, Hospital of The Good Samaritan, University of Southern California School of Medicine, Los Angeles, USA.
Insights
Short-term dexamethasone therapy in extremely low birth weight infants was associated with a higher incidence of severe retinopathy of prematurity (ROP). Further research is needed to confirm if steroid use directly causes ROP.
Area of Science:
- Neonatal Intensive Care
- Pediatric Ophthalmology
- Pharmacology
Background:
- Neonatal intensive care advances have increased survival rates for extremely low birth weight infants.
- Dexamethasone is increasingly used for chronic lung disease in these infants.
- The effect of dexamethasone on retinopathy of prematurity (ROP) is controversial.
Purpose of the Study:
- To evaluate the association between short-term dexamethasone treatment and severe ROP in extremely low birth weight infants.
Main Methods:
- Retrospective study of 309 very low birth weight infants admitted between October 1989 and December 1992.
- Compared 38 dexamethasone-treated infants with 52 non-treated infants (all < 1 kg).
- Analyzed outcomes including severe ROP, mechanical ventilation, oxygen duration, patent ductus arteriosus, and surfactant therapy.
Main Results:
- Dexamethasone-treated infants had longer mechanical ventilation and oxygen duration, higher incidence of patent ductus arteriosus, and more surfactant therapy.
- Severe ROP (stage III or higher) developed in 16 infants, with 12 in the dexamethasone group (p < 0.003).
- Nine of 13 infants requiring cryotherapy were from the dexamethasone-treated group (p < 0.13).
Conclusions:
- This study suggests an association between short-term dexamethasone therapy and severe ROP in extremely low birth weight infants.
- Prospective, randomized controlled studies are necessary to establish a causal role for steroid therapy in ROP.
- Careful consideration of dexamethasone's indications, dosage, and timing is crucial in extremely low birth weight infants.
Abstract:
With advances in neonatal intensive care survival of extremely low birth weight (< 1 kg) infants has increased significantly over the past decade. Dexamethasone is used increasingly for the prevention and treatment of chronic lung disease in these infants. The impact of dexamethasone therapy on the incidence or severity of retinopathy of prematurity (ROP) remains controversial. We conducted a retrospective study to evaluate the association between short-term dexamethasone treatment and severe ROP in extremely low birth weight infants. From October 1989 to December 1992, 309 very low birth weight infants were admitted to the neonatal intensive care unit. A total of 266 infants (86%) survived until hospital discharge. Of these, 90 weighed less than 1 kg. Thirty-eight of 90 infants received short-term dexamethasone therapy for chronic lung disease and the remaining 52 infants did not. Infants treated with dexamethasone and those not treated with dexamethasone were comparable in birth weight (820 vs 828 gm), gestational age (26.5 vs 26.9 weeks), inborn (11 vs 14), and occurrence of sepsis (13/38 vs 21/52). Infants treated with dexamethasone required longer periods of mechanical ventilation (44 +/- 23 vs 26 +/- 15 days, p < 0.001), had longer duration of supplemental oxygen (57 +/- 28 vs 29 +/- 23 days, p < 0.001), had higher incidence of patent ductus arteriosus (28/38 vs 18/52, p < 0.0003), and required surfactant therapy more often for respiratory distress syndrome (17/38 vs 11/52, p < 0.01), when compared with infants who did not receive dexamethasone. Severe ROP developed in 16 infants (stage III or higher); 12 of these were in the dexamethasone-treated group (p < 0.003). Thirteen infants required cryotherapy; nine were from the dexamethasone-treated group (p < 0.13). This study demonstrates an apparent association between the incidence of severe ROP and dexamethasone therapy. Prospective, randomized, controlled studies are needed to correct for differences in severity of cardiorespiratory illness to establish whether a causal role exists for steroid therapy in ROP. Until such studies are available, careful consideration must be given to indications, dosage, time of initiation, and duration of treatment with dexamethasone in extremely low birth weight infants.
