Controlled trial of dexamethasone in neonatal chronic lung disease: an 8-year follow-up of cardiopulmonary function and growth.
OBJECTIVE
To evaluate the long-term effects of postnatal dexamethasone treatment in high-risk infants of very low birthweight.


METHODS
The study included 16 children aged 7.8 to 9.2 y who had been born very prematurely at gestational ages of 24-29 wk and with birthweights of < 1500 g and who had participated in a randomized study of dexamethasone or placebo treatment in ventilator-dependent infants at 10 d of age. Flow-volume spirometry, impulse oscillometry, skin-prick tests and Doppler echocardiography were carried out at school age, and respiratory morbidity and overall neurological outcome evaluated. Controls were 18 non-atopic children born at term, tested for lung function.


RESULTS
No significant differences were found in respiratory morbidity at school age between the dexamethasone (n = 8) and placebo (n = 8) groups. Six of the 16 children had moderate to severe neurosensory impairments, but all were able to walk without support and attended primary school. In prematurely born children, standardized height was significantly less than that in controls, but between the two study groups, no significant differences existed in somatic growth. Atopy was uncommon: skin-prick tests were positive in only one child in the placebo group. In the dexamethasone group, forced vital capacity adjusted to height was significantly higher than that in the placebo group, but impairment of basic lung function and bronchial obstruction was evident in both study groups. No hypertrophic cardiomyopathy was apparent, and non-invasive measurements of pulmonary arterial pressure did not reveal any significant difference between the study groups.


CONCLUSIONS
In very low-birthweight children, high respiratory morbidity and neurological impairment continued until school age. Neonatal dexamethasone treatment at school age was not associated with any detectable adverse effects on somatic growth, or pulmonary or cardiac function.
Mieskonen
S
S
Department of Pediatrics, Jorvi Hospital, Espoo, Finland. suvi.mieskonen@hus.fi
Eronen
M
M
Malmberg
L P
LP
Turpeinen
M
M
Kari
M A
MA
Hallman
M
M
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002648:Child; D002908:Chronic Disease; D003907:Dexamethasone / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D019102:Infant, Very Low Birth Weight; D008171:Lung Diseases / Q000188:drug therapy*; D012129:Respiratory Function Tests; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone