title: Early neonatal dexamethasone treatment for prevention of bronchopulmonary dysplasia. Randomised trial and meta-analysis evaluating the duration of dexamethasone therapy.
abstract: The aim of the aborted trial was to determine whether the short early dexamethasone (DX) given after the birth improves the early outcome. We also reviewed the evidence (meta-analysis) to determine whether the duration of early DX treatment influences the early outcome, particularly in terms of bronchopulmonary dysplasia (BPD). The participants of the randomised multicentre, double-blinded placebo-controlled trial had a birth weight 500-999 g, gestation < or = 31.0 weeks, and respiratory failure by the age of 4 h. The infants received either four doses of DX (0.25 mg/kg at 12 h intervals) or placebo. The meta-analysis was performed to determine the beneficial and adverse effects of early short (<96 h duration) versus early prolonged (>96 h) DX treatment. The trial was discontinued after 109 infants had been enrolled. There was a non-significant improvement in the outcome (survival without BPD, severe intracranial haemorrhage or periventricular leukomalacia; RR 1.27; 95% CI 0.87-1.85). The risks for gastrointestinal perforation and hyperglycaemia tended to increase. A total of 15 trials were included in the meta-analysis: 10 involved prolonged (i.e. >96 h; 1594 infants) and five short interventions (1069 infants). Early prolonged DX decreased the RR for BPD to 0.72 (95% CI 0.61-0.87), whereas early short DX course did not significantly decrease the risk (RR 0.82; 95% CI 0.64-1.05). Gastrointestinal haemorrhages and perforations were significantly increased only in the early prolonged DX group.
  
  
  CONCLUSIONS
  The dosage and duration of early corticosteroid given to small premature infants influences the risk of the side-effects and the early outcome.
authors.affiliation: Department of Paediatrics, University of Oulu, 5000, 90014 Oulu, Finland.
authors.forename: Eija
authors.initials: E
authors.lastname: Anttila
authors.forename: Outi
authors.initials: O
authors.lastname: Peltoniemi
authors.forename: Dominique
authors.initials: D
authors.lastname: Haumont
authors.forename: Egbert
authors.initials: E
authors.lastname: Herting
authors.forename: Henk
authors.initials: H
authors.lastname: ter Horst
authors.forename: Kirsti
authors.initials: K
authors.lastname: Heinonen
authors.forename: Pentti
authors.initials: P
authors.lastname: Kero
authors.forename: Päivi
authors.initials: P
authors.lastname: Nykänen
authors.forename: Sidarto Bambang
authors.initials: SB
authors.lastname: Oetomo
authors.forename: Mikko
authors.initials: M
authors.lastname: Hallman
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control*; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone