Delayed Dexamethasone Therapy and Neurodevelopmental Outcomes in Preterm Infants with Bronchopulmonary Dysplasia
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-weigh...
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Elsevier
2015-08-01
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| Series: | Pediatrics and Neonatology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1875957214002009 |
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| author | Gina Lim Byong Sop Lee Yong-Sung Choi Hye Won Park Mi Lim Chung Hyun Jin Choi Ellen Ai-Rhan Kim Ki-Soo Kim |
| author_facet | Gina Lim Byong Sop Lee Yong-Sung Choi Hye Won Park Mi Lim Chung Hyun Jin Choi Ellen Ai-Rhan Kim Ki-Soo Kim |
| author_sort | Gina Lim |
| collection | DOAJ |
| description | 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.
Conclusion: 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. |
| format | Article |
| id | doaj-art-6aa7dbfa7e174025806c8a620431fcd6 |
| institution | OA Journals |
| issn | 1875-9572 |
| language | English |
| publishDate | 2015-08-01 |
| publisher | Elsevier |
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| series | Pediatrics and Neonatology |
| spelling | doaj-art-6aa7dbfa7e174025806c8a620431fcd62025-08-20T02:06:06ZengElsevierPediatrics and Neonatology1875-95722015-08-0156426126710.1016/j.pedneo.2014.11.006Delayed Dexamethasone Therapy and Neurodevelopmental Outcomes in Preterm Infants with Bronchopulmonary DysplasiaGina Lim0Byong Sop Lee1Yong-Sung Choi2Hye Won Park3Mi Lim Chung4Hyun Jin Choi5Ellen Ai-Rhan Kim6Ki-Soo Kim7Department of Pediatrics, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of KoreaDepartment of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of KoreaDepartment of Pediatrics, School of Medicine, Kyung Hee University, Seoul, Republic of KoreaDepartment of Pediatrics, College of Medicine, Konkuk University, Seoul, Republic of KoreaDepartment of Pediatrics, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of KoreaDepartment of Pediatrics, College of Medicine, Seoul National University, Seoul, Republic of KoreaDepartment of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of KoreaDepartment of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of KoreaIt 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. Conclusion: 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.http://www.sciencedirect.com/science/article/pii/S1875957214002009bronchopulmonary dysplasiadexamethasoneneurodevelopmental outcomevery-low-birth-weight infants |
| spellingShingle | Gina Lim Byong Sop Lee Yong-Sung Choi Hye Won Park Mi Lim Chung Hyun Jin Choi Ellen Ai-Rhan Kim Ki-Soo Kim Delayed Dexamethasone Therapy and Neurodevelopmental Outcomes in Preterm Infants with Bronchopulmonary Dysplasia Pediatrics and Neonatology bronchopulmonary dysplasia dexamethasone neurodevelopmental outcome very-low-birth-weight infants |
| title | Delayed Dexamethasone Therapy and Neurodevelopmental Outcomes in Preterm Infants with Bronchopulmonary Dysplasia |
| title_full | Delayed Dexamethasone Therapy and Neurodevelopmental Outcomes in Preterm Infants with Bronchopulmonary Dysplasia |
| title_fullStr | Delayed Dexamethasone Therapy and Neurodevelopmental Outcomes in Preterm Infants with Bronchopulmonary Dysplasia |
| title_full_unstemmed | Delayed Dexamethasone Therapy and Neurodevelopmental Outcomes in Preterm Infants with Bronchopulmonary Dysplasia |
| title_short | Delayed Dexamethasone Therapy and Neurodevelopmental Outcomes in Preterm Infants with Bronchopulmonary Dysplasia |
| title_sort | delayed dexamethasone therapy and neurodevelopmental outcomes in preterm infants with bronchopulmonary dysplasia |
| topic | bronchopulmonary dysplasia dexamethasone neurodevelopmental outcome very-low-birth-weight infants |
| url | http://www.sciencedirect.com/science/article/pii/S1875957214002009 |
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