Postnatal Dexamethasone, Respiratory and Neurodevelopmental Outcomes at Two Years in Babies Born Extremely Preterm

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2017 Jul 21

PMID 28723921

Citations 12

Authors

Gordon Qin

Jessica W Lo

Neil Marlow

Sandy A Calvert

Anne Greenough

Janet L Peacock

Affiliations

Soon will be listed here.

Abstract

Importance: Postnatal dexamethasone is associated with reduction in bronchopulmonary dysplasia. There remains, however, concern that its short-term benefits are accompanied by long-term adverse effects e.g. poorer neurodevelopmental outcomes.

Objective: Our aim was to determine the effects of administration of postnatal dexamethasone on respiratory and neurodevelopmental outcome at two years of age after adjusting for neonatal and infant risk factors.

Materials And Methods: The study included 412 infants born at 23-28 weeks of gestation, 29% had received postnatal dexamethasone. Two outcomes were examined, respiratory hospital admissions in the past 12 months and neurodevelopmental impairment. Logistic regression, adjusted for sex, birthweight z-score, gestation, maternal smoking, oxygen dependency at 36 weeks, airleak, patent ductus arteriosus, pulmonary haemorrhage, major ultrasound abnormality, mode of ventilation and age at assessment, was undertaken.

Results: After adjustment, postnatal dexamethasone was associated with significantly increased proportions of both respiratory hospital readmission: (0.35 vs 0.15, difference = 0.20; 95% CI: 0.08, 0.31) and neurodevelopmental impairment (0.59 vs 0.45, difference = 0.14; 95% CI: 0.02, 0.26).

Conclusions: Postnatal dexamethasone use in extremely preterm infants is associated with increased risks of respiratory hospital admissions and neurodevelopmental impairment. These associations were not explained by excess neonatal morbidities.

Citing Articles

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David J, Foschi C, Greene M, Click K, Hunsinger B, Patra K J Pediatr Pharmacol Ther. 2025; 30(1):84-92.

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Multipotent adult progenitor cells prevent functional impairment and improve development in inflammation driven detriment of preterm ovine lungs.

Neuen S, Ophelders D, Widowski H, Hutten M, Brokken T, van Gorp C Regen Ther. 2024; 27:207-217.

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Neurodevelopment at 24 months corrected age in extremely preterm infants treated with dexamethasone alternatives during the late postnatal period: a cohort study.

Melan N, Pradat P, Godbert I, Pastor-Diez B, Basson E, Picaud J Eur J Pediatr. 2023; 183(2):677-687.

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Prevention of Chronic Morbidities in Extremely Premature Newborns with LISA-nCPAP Respiratory Therapy and Adjuvant Perinatal Strategies.

Balazs G, Balajthy A, Seri I, Hegyi T, Ertl T, Szabo T Antioxidants (Basel). 2023; 12(6).

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Systemic postnatal corticosteroid use for the prevention of bronchopulmonary dysplasia and its relationship to early neurodevelopment in extremely preterm infants.

Esterman E, Goyen T, Jani P, Lowe G, Baird J, Maheshwari R World J Pediatr. 2023; 19(6):586-594.

PMID: 36967444 PMC: 10198830. DOI: 10.1007/s12519-023-00708-8.

References

Mieskonen S, Eronen M, Malmberg L, Turpeinen M, Kari M, Hallman M . Controlled trial of dexamethasone in neonatal chronic lung disease: an 8-year follow-up of cardiopulmonary function and growth. Acta Paediatr. 2003; 92(8):896-904. View

Smith L, Van Asperen P, McKay K, Selvadurai H, Fitzgerald D . Post-natal corticosteroids are associated with reduced expiratory flows in children born very preterm. J Paediatr Child Health. 2011; 47(7):448-54. DOI: 10.1111/j.1440-1754.2010.01992.x. View

Yeh T, Lin Y, Lin H, Huang C, Hsieh W, Lin C . Outcomes at school age after postnatal dexamethasone therapy for lung disease of prematurity. N Engl J Med. 2004; 350(13):1304-13. DOI: 10.1056/NEJMoa032089. View

Baud O . Postnatal steroid treatment and brain development. Arch Dis Child Fetal Neonatal Ed. 2004; 89(2):F96-100. PMC: 1756046. DOI: 10.1136/adc.2003.028696. View

. Dexamethasone therapy in neonatal chronic lung disease: an international placebo-controlled trial. Collaborative Dexamethasone Trial Group. Pediatrics. 1991; 88(3):421-7. View

Baud O, Zupan V, Lacaze-Masmonteil T, Dehan M . Neurological adverse effects of early postnatal dexamethasone in very preterm infants. Arch Dis Child Fetal Neonatal Ed. 1999; 80(2):F159. PMC: 1720898. DOI: 10.1136/fn.80.2.f158b. View

Nixon P, Washburn L, Schechter M, OShea T . Follow-up study of a randomized controlled trial of postnatal dexamethasone therapy in very low birth weight infants: effects on pulmonary outcomes at age 8 to 11 years. J Pediatr. 2007; 150(4):345-50. PMC: 2897232. DOI: 10.1016/j.jpeds.2006.12.013. View

Jones R . Randomized, controlled trial of dexamethasone in neonatal chronic lung disease: 13- to 17-year follow-up study: II. Respiratory status, growth, and blood pressure. Pediatrics. 2005; 116(2):379-84. DOI: 10.1542/peds.2004-1819. View

Doyle L, Ehrenkranz R, Halliday H . Late (> 7 days) postnatal corticosteroids for chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2014; (5):CD001145. DOI: 10.1002/14651858.CD001145.pub3. View

10.

Wilson-Costello D, Walsh M, Langer J, Guillet R, Laptook A, Stoll B . Impact of postnatal corticosteroid use on neurodevelopment at 18 to 22 months' adjusted age: effects of dose, timing, and risk of bronchopulmonary dysplasia in extremely low birth weight infants. Pediatrics. 2009; 123(3):e430-7. PMC: 2846831. DOI: 10.1542/peds.2008-1928. View

11.

Vyas J, Kotecha S . Effects of antenatal and postnatal corticosteroids on the preterm lung. Arch Dis Child Fetal Neonatal Ed. 1998; 77(2):F147-50. PMC: 1720703. DOI: 10.1136/fn.77.2.f147. View

12.

Johnson A, Peacock J, Greenough A, Marlow N, Limb E, Marston L . High-frequency oscillatory ventilation for the prevention of chronic lung disease of prematurity. N Engl J Med. 2002; 347(9):633-42. DOI: 10.1056/NEJMoa020432. View

13.

Gross S, Anbar R, Mettelman B . Follow-up at 15 years of preterm infants from a controlled trial of moderately early dexamethasone for the prevention of chronic lung disease. Pediatrics. 2005; 115(3):681-7. DOI: 10.1542/peds.2004-0956. View

14.

Tschanz S, Burri P . Postnatal lung development and its impairment by glucocorticoids. Pediatr Pulmonol Suppl. 1997; 16:247-9. DOI: 10.1002/ppul.19502308128. View

15.

Khalife N, Glover V, Taanila A, Ebeling H, Jarvelin M, Rodriguez A . Prenatal glucocorticoid treatment and later mental health in children and adolescents. PLoS One. 2013; 8(11):e81394. PMC: 3838350. DOI: 10.1371/journal.pone.0081394. View

16.

Marlow N, Greenough A, Peacock J, Marston L, Limb E, Johnson A . Randomised trial of high frequency oscillatory ventilation or conventional ventilation in babies of gestational age 28 weeks or less: respiratory and neurological outcomes at 2 years. Arch Dis Child Fetal Neonatal Ed. 2006; 91(5):F320-6. PMC: 2672829. DOI: 10.1136/adc.2005.079632. View

17.

Doyle L, Ehrenkranz R, Halliday H . Early (< 8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2014; (5):CD001146. DOI: 10.1002/14651858.CD001146.pub4. View

18.

Peacock J, Lo J, DCosta W, Calvert S, Marlow N, Greenough A . Respiratory morbidity at follow-up of small-for-gestational-age infants born very prematurely. Pediatr Res. 2012; 73(4 Pt 1):457-63. DOI: 10.1038/pr.2012.201. View