Effects of Early Dexamethasone Administration on Respiratory Outcome in VLBW Infants With Respiratory Distress Syndrome (Rds) Treated With Surfactant (S).† 1480

Tapia, José Luís; Ramírez, Rodrigo; Cifuentes, J. A. Brochero; Fabres, Jorge; Hubner, Magdalena; Bancalari, Aldo; Mercado, M.Eugenia; Stauden, Jane; Escobar, Marisol

doi:10.1203/00006450-199604001-01503

Cited by 2 publications

(13 citation statements)

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“…The ERR and NNT of the subgroup where dexamethasone was started between 7 and 14 days34-36 were 0.83 (0.72, 0.95) and 6 (4, 20), respectively. The findings in the surfactant subgroup30 31 34 35 39 did not differ from the overall analysis [ERR 0.73 (0.60- 0.90)]. There was significant heterogeneity in the results of the trials.…”

Section: Resultsmentioning

confidence: 82%

“…In the overall31 33-36 38 39 (table 6) and all three subgroup analyses there was a significant reduction in CLD in the neonates given dexamethasone. The results suggest that eight infants would need to be treated with dexamethasone to prevent one infant developing CLD at 28 days in the overall analyses.…”

Section: Resultsmentioning

confidence: 90%

“…In the neonates given dexamethasone, the overall analysis30-32 34 35 39 showed a significant reduction in CLD (table 7). Similar results were obtained in the subgroup where surfactant30-32 34 35 38 39 was used [ERR 0.57 (0.43, 0.75)].…”

Section: Resultsmentioning

confidence: 96%

“…The results suggest that eight infants would need to be treated with dexamethasone to prevent one infant developing CLD at 28 days in the overall analyses. In the subgroup where dexamethasone was started within 36 hours,30 31 33 38 39 the ERR and NNT were 0.64 (0.49, 0.83) and 8 (5–16), respectively. The ERR and NNT of the subgroup where dexamethasone was started between 7 and 14 days34-36 were 0.83 (0.72, 0.95) and 6 (4, 20), respectively.…”

Section: Resultsmentioning

confidence: 99%

“…39 One of the abstracts was in the process of being submitted for publication. Additional information was sought from the authors of these abstracts and also of the published studies as required.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review and meta-analysis of early postnatal dexamethasone for prevention of chronic lung disease

Bhuta

Ohlsson²

1998

Archives of Disease in Childhood - Fetal and Neonatal Edition

134

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Aim-To review systematically the evidence to determine whether dexamethasone treatment of very low birthweight infants begun within 14 days of age prevents chronic lung disease (CLD) without clinically significant side eVects. Methods-Randomised controlled trials of dexamethasone started within this time frame were identified through a search of electronic databases, proceedings of scientific meetings, and personal files. Metaanalyses using event rate ratio (ERR), event rate diVerence (ERD), and if significant, numbers needed to treat (NNT) for benefits and numbers needed to harm (NNH) for adverse eVects were calculated. Weighted mean diVerence were used for continuous variables. Three prespecified subgroup analyses were performed for; (i) dexamethasone begun within 36 hours (hours) of birth; (ii) dexamethasone initiated between 7-14 days of age; or (iii) if surfactant treatment was used. Results-Ten studies were included in the review; six where dexamethasone was initiated within 36 hours of age, four studies for dexamethasone started between 7 and 14 days and six studies using surfactant. Mortality ERR and NNT with 95% confidence intervals for dexamethasone initiated at 7-14 days of age were 0.35 (0.16, 0.74) and 8 (4, 30). ERRs and NNTs for CLD at 28 days and 36 weeks of postmenstrual age were 0.71 (0.61, 0.84), 8 (5, 17), and 0.57 (0.44, 0.76), 10 (6, 23) in the overall analyses. When dexamethasone was started at 7 to 14 days of age ERR and NNT for CLD at 36 weeks were 0.63 (0.47, 0.85) and 3 (2, 9). Clinically significant side eVects included increased risk of hypertension, hyperglycaemia, and increased time to regain birthweight. Conclusions-These meta-analyses show a significant reduction in risk of CLD at 28 days and 36 weeks of postmenstrual age. In the subgroup where dexamethasone was started between 7 and 14 days of age mortality was significantly reduced. Caution is warranted in the routine use of dexamethasone because of lack of data on long term neurodevelopmental outcomes.

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Section: Resultsmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Systematic review and meta-analysis of early postnatal dexamethasone for prevention of chronic lung disease

Bhuta

Ohlsson²

1998

Archives of Disease in Childhood - Fetal and Neonatal Edition

134

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Glucocorticoids and lung development in the fetus and preterm infant

Bolt

Weissenbruch

Lafeber

et al. 2001

Pediatric Pulmonology

263

197

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During the final prenatal period of fetal lung development in humans, important maturational processes occur, including the production of surfactant necessary to decrease surface tension at the air-liquid interface of the alveoli. During early gestation, the glucocorticoid receptor is expressed in the fetal lung, and glucocorticoids stimulate the production of surfactant-associated proteins and increase phospholipid synthesis by enhancing the activity of phosphatidylcholine. Other glucocorticoid-induced effects may include stimulation of cell maturation and differentiation, inhibition of DNA synthesis, changes in interstitial tissue components, stimulation of antioxidant enzymes, and regulation of pulmonary fluid metabolism. Recently, it was suggested that glucocorticoids are also important in postnatal pulmonary development, and may be related to the development of neonatal lung disease in preterm infants. Surfactant deficiency that can be prevented by antenatal corticosteroid treatment causes infant respiratory distress syndrome and requires mechanical ventilation. Ventilation by itself or in combination with high levels of oxygen, fluid overload, pulmonary infections, sepsis, and air leak syndrome causes an acute pulmonary inflammatory reaction that may result in chronic lung disease or bronchopulmonary dysplasia. Glucocorticoids are effective in the treatment of chronic lung disease of prematurity and regulate the inflammatory response by the interaction with transcription factors such as nuclear factor kappaB and activated protein 1. Indeed, inflammatory cells and the levels of chemokines and cytokines in bronchoalveolar fluid decrease after dexamethasone treatment. However, treatment of fetuses and preterm infants with repeated and/or high doses of corticosteroids may have considerable long-term side effects on somatic, brain, and lung growth. The difficult balance between short-term gain and the possible long-term side effects of glucocorticoids in preterms remains a difficult issue.

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Effects of Early Dexamethasone Administration on Respiratory Outcome in VLBW Infants With Respiratory Distress Syndrome (Rds) Treated With Surfactant (S).† 1480

Cited by 2 publications

References 0 publications

Systematic review and meta-analysis of early postnatal dexamethasone for prevention of chronic lung disease

Systematic review and meta-analysis of early postnatal dexamethasone for prevention of chronic lung disease

Glucocorticoids and lung development in the fetus and preterm infant

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