A randomized trial of two dexamethasone regimens to reduce side‐effects in infants treated for chronic lung disease of prematurity

Odd, D E; Armstrong, D L; Teele, RL; Kuschel, CA; Harding, Jane E.

doi:10.1111/j.1440-1754.2004.00364.x

Cited by 23 publications

(15 citation statements)

References 30 publications

(76 reference statements)

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“…Starting doses of DXM might have a greater effect on the integrity of the central nervous system than the cumulative doses of DXM. This hypothesis is supported by 2 randomized trials that reported comparable neurodevelopmental outcomes at 18 months between infants treated with similar starting doses (0.5 mg/kg/day) but different cumulative DXM doses [21,26]. …”

Section: Discussionsupporting

confidence: 60%

“…Although conclusive data on neurodevelopment are lacking [2,3,4,5,18,19,20], low-dose DXM treatment seems to be as effective as high-dose DXM treatment in weaning infants off the ventilator, lowering BPD rates, and in decreasing the total duration of supplemental oxygen [2,21]. The rate of BPD in our study, however, was high (94%) compared to previous studies on low-dose DXM, e.g.…”

Section: Discussionmentioning

confidence: 99%

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The Quality of General Movements after Treatment with Low-Dose Dexamethasone in Preterm Infants at Risk of Bronchopulmonary Dysplasia

Hitzert

Roescher²,

Bos³

2014

Neonatology

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Background: High-dose dexamethasone (DXM) treatment of preterms at risk of bronchopulmonary dysplasia leads to a deterioration in quality of their general movements (GMs). It is unknown whether low-dose DXM affects GM quality similarly. Objectives: To assess the effect of low-dose DXM treatment on the quality of GMs and fidgety GMs (FMs). Methods: A prospective study of preterms admitted to our NICU between 2010 and 2012, and treated with DXM (starting dose 0.25 mg/kg/day). We assessed GM/FM quality and calculated their motor optimality score (MOS) before, during, and after treatment up to 3 months postterm. Neurological follow-up was performed between 12 and 36 months. We related risk factors with infants' GM trajectories and MOSs. At 3 months we compared the MOSs of low-dose DXM infants and a historical cohort of infants treated with high-dose DXM or hydrocortisone. Results: 17 infants were included. GM/FM quality improved in 9 out of 13 initially abnormal infants (p = 0.004). Shorter periods of mechanical ventilation and higher birth weights were associated with better GM trajectories (p = 0.032 and p = 0.042, respectively). Infants starting treatment later had higher MOSs on day 7 (p = 0.047). Low-dose DXM infants had higher MOSs than high-dose DXM infants (β = -0.535; 95% CI -0.594 to -0.132; p = 0.003). Out of 17 infants, 2 died, 14 developed normally, and 1 developed with mild neurodevelopmental impairments. Infants whose GMs/FMs remained normal or improved had better outcomes than infants whose GMs/FMs remained abnormal (p = 0.019). Conclusions: Out of the 17 infants treated with low-dose DXM, 2 died. Of the surviving infants, neurological functioning improved with the majority having normal neurodevelopment at the age of 12-36 months.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

The Quality of General Movements after Treatment with Low-Dose Dexamethasone in Preterm Infants at Risk of Bronchopulmonary Dysplasia

Hitzert

Roescher²,

Bos³

2014

Neonatology

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“…Published and peer-reviewed full-text articles and abstracts in all languages were included. The characteristics of the included studies are provided in Table 1 . Studies that evaluated early-initiated dexamethasone (<8 days of postnatal age) or dexamethasone in established cases of BPD (≥28 days) were excluded.…”

Section: Methodsmentioning

confidence: 99%

Assessment of Postnatal Corticosteroids for the Prevention of Bronchopulmonary Dysplasia in Preterm Neonates

et al. 2021

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IMPORTANCEThe safety of postnatal corticosteroids used for prevention of bronchopulmonary dysplasia (BPD) in preterm neonates is a controversial matter, and a risk-benefit balance needs to be struck. OBJECTIVE To evaluate 14 corticosteroid regimens used to prevent BPD: moderately early-initiated, low cumulative dose of systemic dexamethasone (MoLdDX); moderately early-initiated, medium cumulative dose of systemic dexamethasone (MoMdDX); moderately early-initiated, high cumulative dose of systemic dexamethasone (MoHdDX); late-initiated, low cumulative dose of systemic dexamethasone (LaLdDX); late-initiated, medium cumulative dose of systemic dexamethasone (LaMdDX); late-initiated, high cumulative dose of systemic dexamethasone (LaHdDX); early-initiated systemic hydrocortisone (EHC); late-initiated systemic hydrocortisone (LHC); early-initiated inhaled budesonide (EIBUD); early-initiated inhaled beclomethasone (EIBEC); early-initiated inhaled fluticasone (EIFLUT); late-initiated inhaled budesonide (LIBUD); late-initiated inhaled beclomethasone (LIBEC); and intratracheal budesonide (ITBUD).DATA SOURCES PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, World Health Organization's International Clinical Trials Registry Platform (ICTRP), and CINAHL were searched from inception through August 25, 2020.STUDY SELECTION In this systematic review and network meta-analysis, the randomized clinical trials selected included preterm neonates with a gestational age of 32 weeks or younger and for whom a corticosteroid regimen was initiated within 4 weeks of postnatal age. Peer-reviewed articles and abstracts in all languages were included. DATA EXTRACTION AND SYNTHESISTwo independent authors extracted data in duplicate. Network meta-analysis used a bayesian model. MAIN OUTCOMES AND MEASURES Primary combined outcome was BPD, defined as oxygen requirement at 36 weeks' postmenstrual age (PMA), or mortality at 36 weeks' PMA. The secondary outcomes included 15 safety outcomes. RESULTS A total of 62 studies involving 5559 neonates (mean [SD] gestational age, 26 [1] weeks) were included. Several regimens were associated with a decreased risk of BPD or mortality, including EHC (risk ratio [RR

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“…16 However, 3 small individual RCTs that directly compared high versus low dexamethasone doses, variably defined, have revealed no differences in efficacy (Table 1). [17][18][19] These studies have generally been small and heterogeneous, which makes them difficult to compare.…”

Section: Literature Review Dexamethasonementioning

confidence: 99%

Postnatal Corticosteroids to Prevent or Treat Bronchopulmonary Dysplasia

Watterberg¹

2010

Pediatrics

217

153

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The purpose of this revised statement is to review current information on the use of postnatal glucocorticoids to prevent or treat bronchopulmonary dysplasia in the preterm infant and to make updated recommendations regarding their use. High-dose dexamethasone (0.5 mg/kg per day) does not seem to confer additional therapeutic benefit over lower doses and is not recommended. Evidence is insufficient to make a recommendation regarding other glucocorticoid doses and preparations. The clinician must use clinical judgment when attempting to balance the potential adverse effects of glucocorticoid treatment with those of bronchopulmonary dysplasia. Pediatrics 2010;126:800-808 INTRODUCTIONChronic lung disease (CLD) after preterm birth, also known as bronchopulmonary dysplasia (BPD), a major morbidity of the very preterm infant, is remarkably resistant to therapeutic interventions and negatively affects neurodevelopmental outcomes. [1][2][3][4] In 2002, the American Academy of Pediatrics (AAP), in a policy statement regarding the use of postnatal corticosteroids for prevention or treatment of CLD in preterm infants, concluded that routine dexamethasone therapy for the prevention or treatment of CLD could not be recommended. 5 Instead, the AAP recommended that (1) use of dexamethasone for the prevention or treatment of CLD be limited to randomized, controlled trials (RCTs) with long-term follow-up, (2) alternative corticosteroids undergo further study, and (3) infants currently enrolled in RCTs of corticosteroids receive long-term neurodevelopmental follow-up. The statement added that outside the context of such trials, "the use of corticosteroids should be limited to exceptional clinical circumstances (eg, an infant on maximal ventilatory and oxygen support). In those circumstances, parents should be fully informed about the known short-and long-term risks and agree to treatment." 5 Postnatal use of dexamethasone for BPD has decreased since the publication of the AAP statement; however, the incidence of BPD has not decreased. 6 Instead, several reports have suggested that the incidence or severity of BPD may have increased. 4,7,8 Moreover, results of additional clinical trials, meta-analyses, and follow-up studies have been published, warranting a review of the new information and revision of the statement. The objectives of this revised statement are to review data published since the 2002 AAP statement and to reexamine previous recommendations for the use of glucocorticoid therapy in view of new information. COMMITTEE ON FETUS AND NEWBORNKEY WORDS bronchopulmonary dysplasia, preterm infant, glucocorticoid, dexamethasone, chronic lung disease ABBREVIATIONS CLD-chronic lung disease BPD-bronchopulmonary dysplasia AAP

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A randomized trial of two dexamethasone regimens to reduce side‐effects in infants treated for chronic lung disease of prematurity

Abstract: The individualized course of dexamethasone used in this study reduced the total dose of dexamethasone administered but did not significantly reduce side-effects of treatment or alter outcome in infants at risk of chronic lung disease.

Cited by 23 publications

References 30 publications

The Quality of General Movements after Treatment with Low-Dose Dexamethasone in Preterm Infants at Risk of Bronchopulmonary Dysplasia

The Quality of General Movements after Treatment with Low-Dose Dexamethasone in Preterm Infants at Risk of Bronchopulmonary Dysplasia

Assessment of Postnatal Corticosteroids for the Prevention of Bronchopulmonary Dysplasia in Preterm Neonates

Postnatal Corticosteroids to Prevent or Treat Bronchopulmonary Dysplasia

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