title: Delayed Dexamethasone Therapy and Neurodevelopmental Outcomes in Preterm Infants with Bronchopulmonary Dysplasia.
abstract: BACKGROUND
  It remains unclear whether the benefit of postnatal corticosteroid as a respiratory rescue therapy outweighs the potential harm of neurodevelopmental impairment (NDI) in very-low-birth-weight infants at risk of bronchopulmonary dysplasia (BPD).
  
  
  METHODS
  We reviewed the charts of very-low-birth-weight infants with oxygen dependency for 28 days or more and who survived until 18-22 months' corrected age. Patients were divided into the delayed (≥21 days after birth) dexamethasone therapy (DDT, n=71) and the control (n=60) groups. NDI was defined by the presence of cerebral palsy, Bayley Mental or Psychomotor Developmental Index less than 70, deafness, or blindness.
  
  
  RESULTS
  The DDT group was more premature and had worse respiratory morbidities before (ventilator-dependent at 21 days, 69% vs. 17%) and after the DDT (moderate/severe BPD, 41% vs. 15%) than the control group. The risk of NDI did not differ between the DDT and the control groups in the entire cohort (odds ratio and 95% confidence interval, 1.309 [0.530-3.237]) or in the propensity-score-matched cohort (n=62; odds ratio and 95% confidence interval, 1.344 [0.455-3.976]). However, in the subgroup of infants exposed to DDT, the cumulative dexamethasone dose greater than 5.0 mg/kg was significantly associated with NDI.
  
  
  CONCLUSIONS
  Among the very-low-birth-weight infants with BPD, there was no definitely harmful effect of DDT on the neurodevelopmental outcome in the short term. However, considering the potential harm of high cumulative doses of dexamethasone on the developing brain, further studies are needed to determine the optimal dosage of DDT to be administered for the prevention of BPD.
authors: Department of Pediatrics, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of Korea.
authors: Gina
authors: G
authors: Lim
authors: Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea. Electronic address: mdleebs@amc.seoul.kr.
authors: Byong Sop
authors: BS
authors: Lee
authors: Department of Pediatrics, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
authors: Yong-Sung
authors: YS
authors: Choi
authors: Department of Pediatrics, College of Medicine, Konkuk University, Seoul, Republic of Korea.
authors: Hye Won
authors: HW
authors: Park
authors: Department of Pediatrics, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea.
authors: Mi Lim
authors: ML
authors: Chung
authors: Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Republic of Korea.
authors: Hyun Jin
authors: HJ
authors: Choi
authors: Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
authors: Ellen Ai-Rhan
authors: EA
authors: Kim
authors: Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
authors: Ki-Soo
authors: KS
authors: Kim
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy*; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D065886:Neurodevelopmental Disorders / Q000139:chemically induced / Q000503:physiopathology*
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone
keywords: bronchopulmonary dysplasia; dexamethasone; neurodevelopmental outcome; very-low-birth-weight infants