Follow-up at 15 years of preterm infants from a controlled trial of moderately early dexamethasone for the prevention of chronic lung disease.
OBJECTIVE
Postnatal dexamethasone treatment of ventilator-dependent preterm infants results in rapid improvement in lung function and reduction in chronic lung disease. However, limited data are available on long-term outcomes after such therapy. We studied growth, neurodevelopmental, and pulmonary outcomes at adolescence in children who had participated in a double-blind, placebo-controlled trial of dexamethasone beginning at 2 weeks of age for the prevention of chronic lung disease.


METHODS
Thirty-six infants (birth weight < or =1250 g and gestational age < or =30 weeks) who were dependent on mechanical ventilation at 2 weeks of age received a 42-day course of dexamethasone, an 18-day course of dexamethasone, or saline placebo. Twenty-two children survived to 15 years (69% of the 42-day dexamethasone group, 67% of the 18-day dexamethasone group and 45% of the control group), and all were evaluated. Intact survival was defined as survival with normal neurologic examination, IQ >70, and receiving education in the regular classroom.


RESULTS
There were no differences among groups for growth or incidence of neurologic abnormalities. The mean IQ for the 42-day dexamethasone group was 85 +/- 10 compared with 60 +/- 20 for the 18-day dexamethasone group and 73 +/- 23 for the control group. All children in the 42-day dexamethasone group were receiving education in the regular classroom compared with only 50% of the 18-day dexamethasone group and 40% of the control group. As a result, intact survival was significantly greater for the 42-day dexamethasone group (69%) than for either the 18-day dexamethasone group (25%) or the control group (18%). Pulmonary function was significantly better for the 42-day dexamethasone group compared with the 18-day dexamethasone group (eg, forced expiratory volume in 1 second: 90 +/- 16 vs 71 +/- 15% predicted, respectively).


CONCLUSIONS
A 42-day course of dexamethasone therapy beginning at 2 weeks of age in preterm infants who are at high risk for severe chronic lung disease was associated with improved long-term neurodevelopmental outcome. Although additional research is needed to establish the optimal steroid preparation, dosage, and duration of therapy, these data support the view that moderately early (beginning at 1-2 weeks) corticosteroid treatment is advantageous for a select group of ventilator-dependent preterm infants.
Gross
Steven J
SJ
State University of New York Upstate Medical University, Syracuse, New York, USA. stevengrossmd@crouse.org
Anbar
Ran D
RD
Mettelman
Barbara B
BB
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control*; D002908:Chronic Disease; D003907:Dexamethasone / Q000008:administration & dosage*; D004519:Education, Special; D005500:Follow-Up Studies; D006128:Growth / Q000187:drug effects*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007360:Intelligence / Q000187:drug effects*; D009460:Neurologic Examination; D012123:Pulmonary Ventilation / Q000187:drug effects; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy / Q000401:mortality; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone