Decreased use of postnatal corticosteroids in extremely preterm infants without increasing chronic lung disease.
BACKGROUND
Postnatal corticosteroids are effective in preventing chronic lung disease in preterm infant. There are concerns that corticosteroid use may be associated with an increased risk of impaired neurodevelopment.


OBJECTIVE
To examine the effect of change in practice with the use of postnatal corticosteroids over an 8-year period in extremely preterm babies on the incidence of chronic lung disease (CLD) and cerebral palsy at 1 year of age.


METHODS
Babies of birth weight <1,000 g or gestational age <28 weeks admitted from 1997 to 2004 were included in this retrospective analysis. The study period was divided into two eras: group 1: 1997-2000, group 2: 2001-2004. Data were collected from the neonatal database, individual records and from the Growth and Development Unit. The outcome measure of CLD was defined as oxygen dependency at 36 weeks postmenstrual age. Data for postnatal corticosteroid usage were collected for the number of babies per year, and total dose.


RESULTS
389 group 1 babies were compared to 368 group 2 babies. There was a significant decrease in the use of dexamethasone from 27% in group 1 to 13% in group 2 (p = 0.0001), and total dose - mg/kg (4.5 +/- 2.9 vs. 2.6 +/- 1.6, p = 0.0001). The incidence of CLD and need for home oxygen was similar between groups. The incidence of cerebral palsy reduced from 10.4% in group 1 to 6.6% in group 2, though this was not statistically significant (OR 0.63; 95% CI 0.3, 1.2.).


CONCLUSIONS
Decreased postnatal corticosteroid use had no impact on the incidence of CLD or need for home oxygen therapy. The trend towards a reduced rate of cerebral palsy requires further investigation.
Seth
Rakesh
R
Division of Neonatology, Mater Mothers' Hospital, University of Queensland, Qld., Australia.
Gray
Peter H
PH
Tudehope
David I
DI
D002908:Chronic Disease; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D008171:Lung Diseases / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D010102:Oxygen Inhalation Therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D028761:Withholding Treatment
D005938:Glucocorticoids; D003907:Dexamethasone