Postnatal dexamethasone exposure and lung function in adolescents born very prematurely

Abstract

We previously demonstrated corticosteroid administration on the neonatal intensive care unit was associated with reduced lung function at 11 to 14 years of age in children born very prematurely. The objective of this observational study was to assess if lung function remained impaired at 16 to 19 years of age in those who had received postnatal corticosteroids and whether the trajectory of lung function with increasing age differed between those who had and had not received corticosteroids. One hundred and fifty-nine children born prior to 29 weeks of gestational age had comprehensive lung function measurements; 49 had received postnatal dexamethasone. Lung function outcomes were compared between those who had and had not received postnatal dexamethasone after adjustment for neonatal factors. Forced expiratory flow at 75%, 50%, 25% and 25–75% of the expired vital capacity, forced expiratory volume in one second, peak expiratory flow and forced vital capacity and lung volumes (total lung capacity and residual volume) were assessed. The majority of results were significantly lower in those who received dexamethasone (between 0.61 to 0.78 standard deviations). Lung function reduced as the number of courses of dexamethasone increased. Between 11 and 14 years and 16 to 19 years, lung function improved in the unexposed group, but forced expiratory flow at 75% of the expired vital capacity and forced expiratory volume in one second deteriorated in those who had received postnatal corticosteroids (p = 0.0006). These results suggest that prematurely born young people who received postnatal corticosteroids may be at risk of premature onset of chronic obstructive pulmonary disease.

Intrauterine growth retardation and lung function of very prematurely born young people

“…There was a significant difference in weight between the two groups with those in the IUGR group being lighter and with a lower BMI, but this was accounted for in the statistical analysis. We have reported that postnatal corticosteroids were associated with poorer lung function in young adults born very prematurely 37 . The proportion of IUGR young adults in this study who received postnatal corticosteroids was higher than in those appropriately grown, but this did not reach statistical significance.…”

“…There were no significant differences in the proportions of the two groups who had received high frequency oscillation ventilation (HFOV) and we have recently reported that use of HFOV in a neonatal randomized trial was not associated with superior lung function in young people 35 . Both BPD 38 and postnatal dexamethasone, 37,42 affect lung function at follow‐up. There was no significant difference in the proportions who had developed BPD or who received postnatal corticosteroids.…”

Corticosteroids in the prevention and treatment of infants with bronchopulmonary dysplasia: Part I. systemic corticosteroids

“…9 Lung function measurements at 16-17 years showed similarly significantly lower results in the dexamethasone receiving group. 10 Although lung function improved between 11-14 years and 16-17 years in unexposed group, the FEF75% and FEV1 deteriorated significantly in the group receiving dexamethasone (p = .0006). 10 The number of hospital readmissions and the extent of the decrease in lung function parameters were dose-dependent.…”

“…[8][9][10] CS administration in the neonatal period was also associated with significantly altered lung function parameters at school age (11-14 years) and in adolescence (16-17 years). 9,10 The airway functions (such as FEF25%-75% or FEV1) and residual volume (RV) of the lungs were both affected in the dexamethasone-treated group at school age. 9 Significantly decreased FEF25%-75% and FEV1 values are presumed to reflect narrowing of small and medium sized bronchi, and increased RV value indicates gas trapping, both being the features of lung damage caused by CS when given early in life.…”

“…7 Systemic PNCSs alleviated the rate of BPD, nevertheless due to their long-term neurodevelopmental and respiratory consequences their standard use is not recommended. [8][9][10][11][12][13][14][15][16] Inhaled CSs (ICSs) were expected to reduce the incidence of BPD without adverse effects, nonetheless this expectation was thwarted with increased rate of mortality in both the neonatal period and at the 18-24-month follow-up. 17,18 New hope came when the ICS budesonide was coadministered with surfactant intratracheally resulting in a 20% decrease in the incidence of BPD without increase in mortality or long-term neurodevelopmental sequelae.…”