Follow up of a randomised trial of two different courses of dexamethasone for preterm babies at risk of chronic lung disease

Abstract

Objectives: To report 18 month outcome of a randomised trial of two courses of dexamethasone to prevent chronic lung disease of prematurity. Study design: Babies of birth weight 1250 g or less ventilated at 7 days of age were randomised to a 42 day reducing course (long) or a 3 day pulsed (pulse) course of dexamethasone. Growth, cardiovascular status, and respiratory and neurodevelopmental outcomes were assessed at 18 months. Results: Seventy six babies were enrolled. Nine died and three were lost to follow up. Babies receiving the long course were weaned off oxygen more quickly than those receiving the pulse course (47% v 69% on oxygen at 28 days; p = 0.01), but there were no differences in 18 month outcomes. However, children averaged −1 SD for growth parameters, half had moderate or severe disability, and 35% and 19% respectively required oxygen at 36 weeks and discharge. Conclusions: The dexamethasone course used did not influence long term outcome. However, entry criteria for this study selected a group of babies at high risk of poor long term outcome.

Follow-up of a Randomized, Placebo-Controlled Trial of Postnatal Dexamethasone: Blood Pressure and Anthropometric Measurements at School Age

“…Although our finding of no effect of postnatal dexamethasone on blood pressure is consistent with the findings of others, 19,21,35 antenatal exposure to steroids has been associated with elevated blood pressure in later life both in animal experiments 22,36,37 and in an observa- tional study in humans. 24 Posited explanations for the long-term effects of antenatal steroids on blood pressure include alterations in kidney development, such as reduced nephron number, and alterations in the developing renin-angiotensin system.…”

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

“…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]. …”

Outcomes at School Age after Postnatal Dexamethasone Therapy for Lung Disease of Prematurity

“…We previously reported results from our two-year follow-up study of dexamethasone treatment 9 and from other studies conducted in young children. [10][11][12][13][14][15][16][17][18][19][20][21] These studies indicated that early postnatal dexamethasone therapy might affect somatic growth and neurodevelopmental outcome. Since the results of two-year follow-up cannot always predict future morbidity, there is a compelling need for long-term follow-up.…”