Qualitative assessment of general movements in high-risk preterm infants with chronic lung disease requiring dexamethasone therapy.
OBJECTIVE
The objective of this study was to determine in preterm infants at risk for severe chronic lung disease (1) the quality of general movements (GMs) and (2) the effect of dexamethasone treatment on spontaneous motor activity.


METHODS
In 15 very low birth weight infants the quality of GMs was assessed from repeated videotape recordings. Recordings were made at weekly intervals during the preterm period until term age and thereafter three times until the twentieth postterm week. All infants required dexamethasone therapy, and additional recordings were made a few hours before and 24 hours, 48 hours, and 7 days after dexamethasone was started. The relationship among movement quality, brain ultrasonographic abnormalities, and long-term outcome was explored. Acute effects of dexamethasone on motor activity were examined.


RESULTS
After dexamethasone therapy was started, a significant transient reduction of the quantity of most spontaneous movements (p < 0.05) and a reduction of speed and amplitude of GMs was found (p < 0.05). A significant relationship was found between the severity of brain ultrasonographic abnormalities and the extent to which developmental trajectories of GMs were abnormal (p < 0.001). The development of cerebral palsy was related to the presence of cramped-synchronized movements near term (p < 0.02) and to the absence of fidgety movements at the age of 3 months after term (p < 0.05).


CONCLUSIONS
In preterm infants with severe chronic lung disease and brain lesions, dexamethasone treatment leads to an acute reduction in motility and changes in the speed and amplitude of GMs. Until more is known about long-term neurologic sequelae, a cautious use of systemic dexamethasone therapy in preterm infants is recommended.
Bos
A F
AF
Department of Pediatrics, Beatrix Children's Hospital, Groningen, The Netherlands.
Martijn
A
A
van Asperen
R M
RM
Hadders-Algra
M
M
Okken
A
A
Prechtl
H F
HF
D002908:Chronic Disease; D003907:Dexamethasone / Q000627:therapeutic use*; D004453:Echoencephalography; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D009043:Motor Activity
D005938:Glucocorticoids; D003907:Dexamethasone