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Early dexamethasone therapy in preterm infants: a follow-up study
Insights
Early dexamethasone therapy for premature infants reduced chronic lung disease but caused adverse neuromotor and growth effects in boys. Further research is needed to refine this treatment for better infant outcomes.
Area of Science:
- Neonatal care
- Pediatric pulmonology
- Pharmacology
Background:
- Chronic lung disease (CLD) is a significant complication in premature infants requiring mechanical ventilation.
- Early postnatal dexamethasone has been investigated to prevent CLD.
Purpose of the Study:
- To evaluate the 2-year corrected age outcomes of infants receiving early (<12 hours) dexamethasone therapy for CLD prevention.
- To assess the impact of early dexamethasone on growth, neurodevelopment, and pulmonary function.
Main Methods:
- A double-blind controlled trial involving 133 infants (birth weight 500-1999g) with severe respiratory distress syndrome requiring mechanical ventilation.
- Dexamethasone treatment group received 0.25 mg/kg every 12 hours for 1 week, followed by a 3-week taper.
- Outcomes assessed at 2-year corrected age included medical history, growth, neurological examinations, MDI/PDI scores, pulmonary function, EEG, and evoked potentials.
Main Results:
- Dexamethasone group showed reduced respiratory-related rehospitalizations but had significantly lower body weight and height in boys.
- Higher incidence of neuromotor dysfunction (41.2% vs 31.4%) and lower psychomotor development index (PDI) scores were observed in the dexamethasone group.
- No significant differences were found in mental development index (MDI), vision impairment, or auditory/visual evoked potentials.
Conclusions:
- While early dexamethasone therapy reduces CLD incidence, its current regimen is not recommended due to adverse neuromotor and growth effects in male infants at 2 years.
- Further studies are required to determine optimal dosage, timing, and duration for safe and effective CLD prevention.
- Modifications to the therapeutic regimen are necessary if early dexamethasone is to be used for CLD prevention.
Objectives:
To study the outcome at 2-year corrected age of infants who participated in a double-blind controlled trial of early (<12 hours) dexamethasone therapy for the prevention of chronic lung disease (CLD).
Methods And Materials:
A total of 133 children (70 in the control group, 63 in the dexamethasone-treated group) who survived the initial study period and lived to 2 years of age were studied. All infants had birth weights of 500 to 1999 g and had severe respiratory distress syndrome requiring mechanical ventilation within 6 hours after birth. For infants in the treatment group, dexamethasone was started at a mean age of 8.1 hours and given 0.25 mg/kg every 12 hours for 1 week and then tapered off gradually over a 3-week period. The following variables were evaluated: interim medical history, socioeconomic background, physical growth, neurologic examinations, mental and psychomotor development index score (MDI and PDI), pulmonary function, electroencephalogram, and auditory and visual evoked potential.
Results:
Infants in the control group tended to have a higher incidence of upper respiratory infection and rehospitalization than did the dexamethasone-treated group because of respiratory problems. Although there was no difference between the groups in somatic growth in girls, the dexamethasone-treated boys had significantly lower body weight and shorter height than the control boys (10.7 +/- 3.0 vs 11.9 +/- 2.0 kg; 84.9 +/- 5.7 vs 87.5 +/- 4.8 cm). The dexamethasone-treated group had a significantly higher incidence of neuromotor dysfunction (25/63 vs 12/70) than did the control group. The dexamethasone-treated infants also had a lower PDI score (79 +/- 26) than did the control group (87 +/- 23), but the difference was not statistically significant. Both groups were comparable in MDI, incidence of vision impairment, and auditory and visual evoked potential. Significant handicap, defined as severe neurologic defect and/or intellectual defect (MDI and/or PDI
Conclusions:
Although early postnatal dexamethasone therapy for 4 weeks significantly reduces the incidence of CLD, this therapeutic regimen cannot be recommended at present because of its adverse effects on neuromotor function and somatic growth in male infants, detected at 2 years of age. A longer follow-up is needed. If early dexamethasone therapy is to be used for the prevention of CLD, the therapeutic regimen should be modified. The proper route of administration, the critical time to initiate the therapy, and the dosage and duration of therapy remain to be defined further.