Outcomes at school age after postnatal dexamethasone therapy for lung disease of prematurity.
BACKGROUND
We studied the outcomes at school age in children who had participated in a double-blind, placebo-controlled trial of early postnatal dexamethasone therapy (initiated within 12 hours after birth) for the prevention of chronic lung disease of prematurity.


METHODS
Of the 262 children included in the initial study, 159 lived to school age. Of these children, 146 (72 in the dexamethasone group and 74 in the control group) were included in our study. All the infants had had severe respiratory distress syndrome requiring mechanical ventilation shortly after birth. In the dexamethasone group, 0.25 mg of dexamethasone per kilogram of body weight was given intravenously every 12 hours for one week, and then the dose was tapered. We evaluated the children's growth, neurologic and motor function, cognition, and school performance.


RESULTS
Children in the dexamethasone group were significantly shorter than the controls (P=0.03 for boys, P=0.01 for girls, and P=0.03 for all children) and had a significantly smaller head circumference (P=0.04). Children in the dexamethasone group had significantly poorer motor skills (P<0.001), motor coordination (P<0.001), and visual-motor integration (P=0.02). As compared with the controls, children in the dexamethasone group also had significantly lower full IQ scores (mean [+/-SD], 78.2+/-15.0 vs. 84.4+/-12.6; P=0.008), verbal IQ scores (84.1+/-13.2 vs. 88.4+/-11.8, P=0.04), and performance IQ scores (76.5+/-14.6 vs. 84.5+/-12.7, P=0.001). The frequency of clinically significant disabilities was higher among children in the dexamethasone group than among controls (28 of 72 [39 percent] vs. 16 of 74 [22 percent], P=0.04).


CONCLUSIONS
Early postnatal dexamethasone therapy should not be recommended for the routine prevention or treatment of chronic lung disease, because it leads to substantial adverse effects on neuromotor and cognitive function at school age.
Yeh
Tsu F
TF
Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan. master@mail.cmu.edu.tw
Lin
Yuh J
YJ
Lin
Hung C
HC
Huang
Chao C
CC
Hsieh
Wu S
WS
Lin
Chyi H
CH
Tsai
Cheng H
CH
D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy / Q000517:prevention & control*; D002648:Child; D002908:Chronic Disease; D003907:Dexamethasone / Q000009:adverse effects* / Q000627:therapeutic use; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006128:Growth / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D007360:Intelligence / Q000187:drug effects*; D008171:Lung Diseases / Q000188:drug therapy / Q000517:prevention & control; D008297:Male; D009048:Motor Skills / Q000187:drug effects*; D009460:Neurologic Examination; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy*
D005938:Glucocorticoids; D003907:Dexamethasone