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Early Dexamethasone and FSBP
Focal Small Bowel Perforation: An Adverse Effect of Early Postnatal Dexamethasone Therapy in Extremely Low birth Weight Infants. Gordon PV, Young ML, and Marshall DD. J Perinatol 2001 (April/May); 21: 156-60.
The techniques of meta-analysis were applied to studies of early postnatal dexamethasone (EPD) to test the hypothesis that EPD increases the risk of focal small bowel perforation (FSBP) in extremely low birth weight infants. Studies were included if they were randomized, placebo-controlled trials of EPD (given within the first 48 hours of life), enrolled infants with birth weights < 1000 grams and reported FSBP as an outcome variable. Four studies with a pooled sample size of 1383 infants were included. FSBP was significantly higher in the EPD treated infants (odds ratio 1.91, 95% CI = 1.21-3.07, p =0.004).
Comment. This is the third is a series of articles on this topic by Dr. Gordon since his initial report of this complication in 1999. Earlier articles were reviewed in 1-002 and 1-033 of this publication. This article should put to rest any lingering doubts about whether EPD is associated with FSBP in ELBW infants. Furthermore, this meta-analysis was not able to demonstrate that EPD was associated with a decreased incidence of chronic lung disease. In light of these findings, there seems to be little justification for the use EPD in ELBW infants. Additionally, dexamethasone use in ELBW infants has recently been associated with other adverse effects including abnormal growth and neurodevelopmental outcomes. Perhaps alternative steroid medications such as hydrocortisone will prove to be more efficacious and less harmful than dexamethasone in ELBW infants. For now, we would be wise to minimize steroid use in ELBW infants while we await further studies.