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Follow-up of preterm infants treated with dexamethasone for chronic lung disease
T M O'Shea1, J M Kothadia, K L Klinepeter
1Department of Pediatrics, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC.
Insights
Prolonged dexamethasone treatment in preterm infants on ventilators reduced ventilation days but did not improve 1-year outcomes. Further research is needed before widespread use.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Preterm infants requiring prolonged mechanical ventilation often face significant morbidities.
- Dexamethasone, a corticosteroid, has been explored to improve respiratory outcomes in this vulnerable population.
Purpose of the Study:
- To evaluate the efficacy of a 42-day dexamethasone sodium phosphate treatment course.
- To assess the impact on assisted ventilation duration and long-term neurodevelopmental and growth outcomes in very-low-birth-weight infants.
Main Methods:
- A longitudinal follow-up study utilizing historic controls.
- Sixty-one very-low-birth-weight infants received a 42-day tapered course of dexamethasone sodium phosphate.
- Matched controls (n=61) with similar birth characteristics requiring at least 15 days of assisted ventilation were compared.
Main Results:
- Dexamethasone-treated infants had significantly fewer days of assisted ventilation (33 vs. 47 days, P < .05).
- No significant differences were observed in hospitalization rates for respiratory infections, growth parameters (weight, length, head circumference), cerebral palsy rates, or Bayley developmental scores at 1 year.
- Survival rates were similar between groups.
Conclusions:
- While dexamethasone reduced the duration of mechanical ventilation, it did not lead to improved clinical outcomes at one year of age.
- The study suggests caution regarding the widespread use of dexamethasone in preterm infants dependent on assisted ventilation pending further long-term outcome assessments.
- More research is warranted to fully understand the long-term effects of this intervention.
Objective:
To study the outcome of prolonged treatment with dexamethasone sodium phosphate in preterm infants who depend on assisted ventilation.
Design:
Longitudinal follow-up using historic controls.
Setting:
Regional intensive care nursery.
Participants:
Sixty-one very-low-birth-weight infants treated with a 42-day course of dexamethasone and 61 historic controls matched for birth weight, gestational age, race, and sex. All 122 subjects required assisted ventilation for at least 15 days.
Intervention:
Infants were given dexamethasone sodium phosphate at a dose of 0.5 mg/kg per day. The dose was then tapered over 42 days.
Measurements/Main Results:
Infants treated with dexamethasone received assisted ventilation for a median of 33 days; controls, a median of 47 days (P < .05). One hundred infants survived; 94 were examined at age 1 year. The two groups were similar with respect to the proportions hospitalized for respiratory infection in the first year of life and the proportions with weight, length, and head circumference below the fifth percentile. Rates of cerebral palsy were also similar between the two groups, as were median Bayley Mental and Psychomotor developmental index scores.
Conclusions:
Dexamethasone treatment was associated with fewer days of assisted ventilation, but not with improved outcome at age 1 year. More assessment should be made of dexamethasone's effect on long-term outcome before dexamethasone becomes widely used in preterm infants who depend on assisted ventilation.