The effect of early dexamethasone administration on bronchopulmonary dysplasia in preterm infants with respiratory distress syndrome

Tapia, José Luís; Ramírez, Rodrigo; Cifuentes, J. A. Brochero; Fabres, Jorge; Hübner, María Eugenia; Bancalari, Aldo; Mercado, M.Eugenia; Standen, Jane; Escobar, Marisol

doi:10.1016/s0022-3476(98)70483-4

Cited by 68 publications

(34 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the lung, for example, corticosteroid therapy is central to the prevention of respiratory distress syndrome. Interestingly, several clinical trials using exogenous glucocorticoids in the treatment of prematurity also demonstrated a decreased incidence of necrotizing enterocolitis (NEC) in steroid-treated infants (1)(2)(3). In addition, Halac and coworkers conducted a prospective human study of the effect of DEX on the incidence of NEC and found a significant reduction in NEC among neonates receiving either prenatal or postnatal steroid (4).…”

mentioning

confidence: 99%

Development of Glucocorticoid-Responsiveness in Mouse Intestine

et al. 2001

View full text Add to dashboard Cite

There are conflicting data from human studies regarding the ability of exogenous glucocorticoids to stimulate maturation of the small intestine. The discrepancies may relate to differences in hormone doses and age administered. To explore this general concept, we have used a mouse model to determine intestinal responsiveness to dexamethasone (DEX) at various times during development. We first showed that trehalase mRNA is a sensitive marker of intestinal maturation in the mouse; being undetectable (by Northern blotting) in the prenatal period, expressed at low levels during the first 2 postnatal weeks and then displaying a marked increase in the 3rd postnatal week. DEX was unable to elicit detectable trehalase mRNA in fetal mice, but caused significant increases in the postnatal period. The use of a range of DEX doses (0.0125-2.5 nmol/g BW per day) established that there is no change in sensitivity between the 1st and 2nd postnatal weeks, but there is a significant increase in maximal responsiveness of trehalase mRNA to the hormone. Similar results were obtained when sucrase-isomaltase mRNA was assayed in the same animals. Thus, in this rodent model, there appears to be at least three phases in the DEX responsiveness of the developing intestine: an early phase (prenatal) when DEX is unable to elicit intestinal maturation; then a phase (first postnatal week) of modest responsiveness; then a transition to increased responsiveness. These findings point to the need for careful attention to dose and age in analyses of glucocorticoid effects in human infants. Glucocorticoids have become an important component in the pharmacologic treatment of prematurity because of their maturational effects on certain tissues. In the lung, for example, corticosteroid therapy is central to the prevention of respiratory distress syndrome. Interestingly, several clinical trials using exogenous glucocorticoids in the treatment of prematurity also demonstrated a decreased incidence of necrotizing enterocolitis (NEC) in steroid-treated infants (1-3). In addition, Halac and coworkers conducted a prospective human study of the effect of DEX on the incidence of NEC and found a significant reduction in NEC among neonates receiving either prenatal or postnatal steroid (4). As NEC is typically associated with immaturity (5-7), these findings suggest that exogenous glucocorticoid may exert a maturational effect on the intestine. However, not all trials observed decreased NEC (2). Likewise, although investigators have found significant maturation of intestinal motility (8) and permeability (9) in premature infants whose mothers received prenatal glucocorticoid, another study reported no effect on lactase maturation (10). The latter in vivo observation is in contrast to several studies that have shown elevation of lactase activity in response to glucocorticoid treatment in explant cultures of human fetal intestine (11-13). We hypothesize that such seemingly disparate results may be explained by differences in dosages and timing of corticosteroid tr...

show abstract

mentioning

confidence: 99%

Development of Glucocorticoid-Responsiveness in Mouse Intestine

et al. 2001

View full text Add to dashboard Cite

show abstract

“…Over the past decades, methods have differed as to the beginning of administration of corticosteroids: (i) from the first hours of life (early), 6,[7][8][9]16,[45][46][47] (ii) from 7 to 14 days of life (moderately early), 12,23,48 (iii) after 14 days of life (late) 10,13,49,50 . Doses and the length of treatment (from 9 to 42 days) are also reported.…”

Section: Discussionmentioning

confidence: 99%

“…Several clinical trials have described favorable effects with the use of corticosteroids in the neonatal period, including a reduction of the incidence of BPD, [5][6][7][8][9] the duration of mechanical ventilation, 6,10-13 and short-term improvement in pulmonary compliance.…”

mentioning

confidence: 99%

Effects of Corticosteroids in Very Low Birth Weight Newborns Dependent on Mechanical Ventilation

Mataloun

Leone

Gibelli

et al. 2005

Clinics

View full text Add to dashboard Cite

RESULTS: The incidence of bronchopulmonary dysplasia was 6.5% (Group I) and 30% (Group II), P = .07. A decrease in growth was detected in Group I compared with Group II (change in weight: Group I -47 g/week, Group II -85.5 g/week, P = .06; change in head circumference: Group I -0.75 cm/week, Group II -1 cm/week, P = .05).CONCLUSION: Use of corticosteroids in very low birth weight infants dependent on mechanical ventilation during the first 10 to 14 days of life did not affect the respiratory evolution and occurrence of bronchopulmonary dysplasia, but the velocity of growth was reduced.KEYWORDS: Corticosteroids. Very low birth weight newborn. Bronchopulmonary dysplasia.

show abstract

“…Dados de alguns estudos sugerem que a administração precoce de dexametasona (dentro de 24 a 48 horas depois do parto) poderia prevenir a doença crônica pulmonar 47,48 , mas o uso profilático parece não justificar os potenciais efeitos adversos do tratamento, como hipertensão, hiperglicemia, perfuração gastrintestinal 49 , redução de peso 12 e pequena circunferência craniana 19 .…”

Section: C) Quando Iniciarunclassified

Critical analysis of the use of corticosteroids in the neonatal period

Antunes¹,

Belik²

2001

J Pediatr (Rio J)

View full text Add to dashboard Cite

ARTIGO DE REVISÃO ResumoObjetivo rever o uso terapêutico de esteróides no que diz respeito ao recém-nascido.Métodos: revisão de literatura. Especificamente discutimos a literatura mundial relacionada ao uso de corticosteróides na doença pulmonar crônica, insuficiência adrenal e edema das vias aéreas superiores.Conclusões: apesar dos dados da literatura comprovando uma melhora do quadro clínico de doença pulmonar crônica em curto prazo, não se mostrou diminuição da mortalidade ou morbidade de recém-nascidos tratados com dexametasona. Dada a evidência recente de que o uso dessas drogas em recém-nascidos pode levar a efeitos maléficos irreversíveis no sistema nervoso e no desenvolvimento neurológico, o seu uso indiscriminado deve ser reconsiderado. A indicação clínica do uso de corticosteróides deve se limitar a casos severos de doença pulmonar crônica ou hipotensão arterial recalcitrante ao uso de agentes vasopressores. AbstractObjective: to review the use of corticosteroids in the treatment of newborns with chronic lung disease, adrenal insufficiency and upper airway edema.Sources: review of the available medical literature on the use of corticosteroids in newborns.Summary of the findings: although there is evidence of shortterm clinical improvement of chronic lung disease with the administration of dexamethasone, the available literature did not show significant reduction in neonatal morbidity and mortality associated with this condition.Conclusions: The use of corticosteroids must be carefully analyzed and restricted to the treatment of severe cases, since these drugs may produce irreversible effects on the nervous system and neurological development of newborns. Haddad e colaboradores publicaram o primeiro estudo em recém-nascidos prematuros relatando o uso pós-natal de esteróides em prematuros. Eles concluíram que não houve significativa diminuição na incidência de doença de membrana hialina em 32 recém-nascidos de mãe diabética 2 . Liggins e Howie publicaram o primeiro estudo demonstrando o valor do uso antenatal de esteróides em 1972 3 , relatando a diminuição das taxas de morbi-mortalidade em prematuros. Análise crítica do uso de esteróides no período neonatalEm 1978 o primeiro relato do uso de corticosteróides no tratamento da doença crônica pulmonar em bebês foi feito por Kramer e Hutzen 4 e, desde então, vários estudos têm examinado o uso de esteróides no período perinatal.

show abstract

The effect of early dexamethasone administration on bronchopulmonary dysplasia in preterm infants with respiratory distress syndrome

Cited by 68 publications

References 31 publications

Development of Glucocorticoid-Responsiveness in Mouse Intestine

Development of Glucocorticoid-Responsiveness in Mouse Intestine

Effects of Corticosteroids in Very Low Birth Weight Newborns Dependent on Mechanical Ventilation

Critical analysis of the use of corticosteroids in the neonatal period

Contact Info

Product

Resources

About