Methylprednisolone, an alternative to dexamethasone in very premature infants at risk of chronic lung disease.
OBJECTIVE
To evaluate the benefits and the medium-term side effects of methylprednisolone in very preterm infants at risk of chronic lung disease.


METHODS
Forty-five consecutive preterm infants (< 30 weeks' gestation) at risk of chronic lung disease were treated at a mean postnatal age of 16 days with a tapering course of methylprednisolone. The outcome of treatment was assessed by comparison with 45 consecutive historical cases of infants treated with dexamethasone; the infants did not differ in baseline characteristics.


RESULTS
There were no differences between groups in the rate of survivors without chronic lung disease. Infants treated with methylprednisolone had a higher rate of body weight gain during the treatment period (median 120 g, range 0 to 190, vs. 70 g, range -110 to 210, P = 0.01) and between birth and the age of 40 weeks (median 1660 g, range 1170-2520, vs. 1580 g, range 1,040 to 2,120, P = 0.02). The incidence of both glucose intolerance requiring insulin (0 % vs. 18 %, P = 0.006) and cystic periventricular leukomalacia (2 % vs. 18%, P = 0.03) was lower among methylprednisolone-treated infants.


CONCLUSIONS
Our observations confirm methylprednisolone to be as effective as dexamethasone and to have fewer side effects. A randomized control trial is needed to further study the efficacy and safety of methylprednisolone in very premature infants at risk of chronic lung disease.
André
P
P
Service de Pédiatrie et Réanimation Néonatales, Hopital Antoine Béclère, Assistance Publique, Hopitaux de Paris, France.
Thébaud
B
B
Odièvre
M H
MH
Razafimahefa
H
H
Zupan
V
V
Dehan
M
M
Lacaze-Masmonteil
T
T
D001997:Bronchopulmonary Dysplasia / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D002908:Chronic Disease; D003907:Dexamethasone / Q000494:pharmacology / Q000627:therapeutic use*; D002149:Energy Intake / Q000187:drug effects; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008775:Methylprednisolone / Q000494:pharmacology / Q000627:therapeutic use*; D010865:Pilot Projects; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D015430:Weight Gain / Q000187:drug effects
D003907:Dexamethasone; D008775:Methylprednisolone