NeoNotes
Journal Club
Andrew B. Kairalla MD, Editor
6-010| Additional Comments | Previous
Article | Next Article | Search
| List of Articles | Submit
Comments | Index | FSN Home Page
More on Postnatal Steroids
Objective. 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 1250g and gestational age 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.
Comments: Like the previous study, this one should stir up some good discussion about the relative risks and benefits of using systemic corticosteroids in premature infants who remain ventilator dependent at 2 weeks of age. I don’t think that the present data support going back to the days of widespread steroid use to prevent CLD in preterm infants. However, there appears to be more justification for considering this treatment in that group of babies with more significant lung disease. I think the door is now open for more studies to better define the group most likely to benefit from this treatment. ABK
Date: 11 Mar 2005
Time: 17:44:02
I think we should use it in confirmed cases of BPD (severe) and not as a preventive routine.
UserName: Antonio Teixeira
Institution: Hospital Santo Amaro
telephone: +51 71 33585766
email:
allw0604@terra.com.br
You may add your own comments to the discussion of this topic by selecting : Submit Comments.