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Follow-up at 15 years of preterm infants from a controlled trial of moderately early dexamethasone for the prevention of chronic lung disease.

AbstractOBJECTIVE:
Postnatal dexamethasone treatment of ventilator-dependent preterm infants results in rapid improvement in lung function and reduction in chronic lung disease. However, limited data are available on long-term outcomes after such therapy. We studied growth, neurodevelopmental, and pulmonary outcomes at adolescence in children who had participated in a double-blind, placebo-controlled trial of dexamethasone beginning at 2 weeks of age for the prevention of chronic lung disease.
METHODS:
Thirty-six infants (birth weight < or =1250 g and gestational age < or =30 weeks) who were dependent on mechanical ventilation at 2 weeks of age received a 42-day course of dexamethasone, an 18-day course of dexamethasone, or saline placebo. Twenty-two children survived to 15 years (69% of the 42-day dexamethasone group, 67% of the 18-day dexamethasone group and 45% of the control group), and all were evaluated. Intact survival was defined as survival with normal neurologic examination, IQ >70, and receiving education in the regular classroom.
RESULTS:
There were no differences among groups for growth or incidence of neurologic abnormalities. The mean IQ for the 42-day dexamethasone group was 85 +/- 10 compared with 60 +/- 20 for the 18-day dexamethasone group and 73 +/- 23 for the control group. All children in the 42-day dexamethasone group were receiving education in the regular classroom compared with only 50% of the 18-day dexamethasone group and 40% of the control group. As a result, intact survival was significantly greater for the 42-day dexamethasone group (69%) than for either the 18-day dexamethasone group (25%) or the control group (18%). Pulmonary function was significantly better for the 42-day dexamethasone group compared with the 18-day dexamethasone group (eg, forced expiratory volume in 1 second: 90 +/- 16 vs 71 +/- 15% predicted, respectively).
CONCLUSION:
A 42-day course of dexamethasone therapy beginning at 2 weeks of age in preterm infants who are at high risk for severe chronic lung disease was associated with improved long-term neurodevelopmental outcome. Although additional research is needed to establish the optimal steroid preparation, dosage, and duration of therapy, these data support the view that moderately early (beginning at 1-2 weeks) corticosteroid treatment is advantageous for a select group of ventilator-dependent preterm infants.
AuthorsSteven J Gross, Ran D Anbar, Barbara B Mettelman
JournalPediatrics (Pediatrics) Vol. 115 Issue 3 Pg. 681-7 (Mar 2005) ISSN: 1098-4275 [Electronic] United States
PMID15741372 (Publication Type: Journal Article)
Chemical References
  • Anti-Inflammatory Agents
  • Dexamethasone
Topics
  • Adolescent
  • Anti-Inflammatory Agents (administration & dosage)
  • Bronchopulmonary Dysplasia (prevention & control)
  • Chronic Disease
  • Dexamethasone (administration & dosage)
  • Education, Special
  • Follow-Up Studies
  • Growth (drug effects)
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Intelligence (drug effects)
  • Neurologic Examination
  • Pulmonary Ventilation (drug effects)
  • Respiration, Artificial
  • Respiratory Distress Syndrome, Newborn (drug therapy, mortality)
  • Treatment Outcome

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