Dexamethasone dosing, mechanical ventilation and the risk of cerebral palsy.
OBJECTIVE
Risk factors for cerebral palsy (CP) in premature infants include duration of mechanical ventilation and exposure to postnatal dexamethasone (DEX). Since DEX can reduce the duration of mechanical ventilation, limited DEX exposure could be beneficial.


METHODS
This was a retrospective, cohort study of infants of less than 1500 g birth weight surviving to discharge between 1 January 1996 and 30 June 2001 who received postnatal dexamethasone. DEX administration was based only on the need for O2 and/or mechanical ventilation. CP was diagnosed at over 10 months post-conceptional age. Univariate and multivariate analyses were used to determine significant risk factors and the relative contribution of these factors to overall risk of CP.


RESULTS
Of 218 eligible infants 162 were followed-up (74%). The CP rate was 27.3%. Significant risk factors for CP included gestational age, ventilator duration, DEX dose, presence of periventricular leukomalacia (PVL), seizures, diagnosis of retinopathy of prematurity (ROP) and use of vasopressors. By multiple logistic regression, ventilator duration, PVL, grade III/IV intraventricular hemorrhage (IVH) and DEX dose were significantly related to CP. By stepwise multiple regression, grade III/IV IVH and ventilator duration were the strongest risk factors, but DEX dose continued to be a significant risk factor.


CONCLUSIONS
The risk of CP was significantly related to the total cumulative dose of DEX. This could be due to a smaller exposure to DEX or to a reduced need for mechanical ventilation.
Powell
Kristen
K
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Virginia Commonwealth University Health Systems, Richmond, VA 23298-0276, USA.
Kerkering
Kathryn W
KW
Barker
Gail
G
Rozycki
Henry J
HJ
D000328:Adult; D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control; D002543:Cerebral Hemorrhage / Q000150:complications; D002547:Cerebral Palsy / Q000453:epidemiology / Q000209:etiology*; D002552:Cerebral Ventricles; D015331:Cohort Studies; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control; D019102:Infant, Very Low Birth Weight; D007969:Leukomalacia, Periventricular / Q000150:complications; D016015:Logistic Models; D008297:Male; D011181:Postnatal Care; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000150:complications; D012720:Severity of Illness Index; D013997:Time Factors; D014768:Virginia / Q000453:epidemiology
D005938:Glucocorticoids; D003907:Dexamethasone