title: The quality of general movements after treatment with low-dose dexamethasone in preterm infants at risk of bronchopulmonary dysplasia.
abstract: BACKGROUND
  High-dose dexamethasone (DXM) treatment of preterms at risk of bronchopulmonary dysplasia leads to a deterioration in quality of their general movements (GMs). It is unknown whether low-dose DXM affects GM quality similarly.
  
  
  OBJECTIVE
  To assess the effect of low-dose DXM treatment on the quality of GMs and fidgety GMs (FMs).
  
  
  METHODS
  A prospective study of preterms admitted to our NICU between 2010 and 2012, and treated with DXM (starting dose 0.25 mg/kg/day). We assessed GM/FM quality and calculated their motor optimality score (MOS) before, during, and after treatment up to 3 months postterm. Neurological follow-up was performed between 12 and 36 months. We related risk factors with infants' GM trajectories and MOSs. At 3 months we compared the MOSs of low-dose DXM infants and a historical cohort of infants treated with high-dose DXM or hydrocortisone.
  
  
  RESULTS
  17 infants were included. GM/FM quality improved in 9 out of 13 initially abnormal infants (p = 0.004). Shorter periods of mechanical ventilation and higher birth weights were associated with better GM trajectories (p = 0.032 and p = 0.042, respectively). Infants starting treatment later had higher MOSs on day 7 (p = 0.047). Low-dose DXM infants had higher MOSs than high-dose DXM infants (β = -0.535; 95% CI -0.594 to -0.132; p = 0.003). Out of 17 infants, 2 died, 14 developed normally, and 1 developed with mild neurodevelopmental impairments. Infants whose GMs/FMs remained normal or improved had better outcomes than infants whose GMs/FMs remained abnormal (p = 0.019).
  
  
  CONCLUSIONS
  Out of the 17 infants treated with low-dose DXM, 2 died. Of the surviving infants, neurological functioning improved with the majority having normal neurodevelopment at the age of 12-36 months.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Marrit M
authors.initials: MM
authors.lastname: Hitzert
authors.forename: Annemiek M
authors.initials: AM
authors.lastname: Roescher
authors.forename: Arend F
authors.initials: AF
authors.lastname: Bos
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D002657:Child Development / Q000187:drug effects; D003071:Cognition / Q000187:drug effects / Q000502:physiology; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D009068:Movement / Q000187:drug effects*; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D003907:Dexamethasone; D006854:Hydrocortisone