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Conference Highlights from Hot Topics in Neonatology Washington, DC; Dec 9-11, 2001
Postnatal Steroids Session, m
oderated by Alan, Jobe MDThe OSECT Study, Halliday HL et al, Pediatrics 2001; 107 : 232-240.
570 infants < 30 weeks EGA who were being ventilated with > 30% oxygen within 72 hours of birth were randomized to one of 4 possible treatment regimens:
Results. There were no significant differences between groups in the primary outcome of survival without CLD at 36 weeks CGA. For death before discharge, dexamethasone and early treatment had worse outcomes than budesonide and delayed, selective treatment with results almost reaching statistical significance. Dexamethasone was associated with an increased risk of hypertension and GI problems. In light of the increased risk of cerebral palsy earlier (2-053; 2-054), Dr. Halliday recommended steroid use for ventilator-dependent infants requiring > 60% oxygen and with a high risk of dying on the ventilator. He would then seek informed parental consent, and use a low-dose dexamethasone (0.05 mg/kg/d or less) and short course (6 days maximum). His goal of treatment would be extubation within 3-4 days.
Comment. It appears that inhaled budesonide for CLD may be safer than IV dexamethasone in preterm infants, but there is no clear evidence that it is more of less effective. Long-term neuro-developmental follow-up of survivors from the OSECT study is in progress, but results will not be available for at least 3 years.
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