Outcomes at School Age after Postnatal Dexamethasone Therapy for Lung Disease of Prematurity
Journal
New England Journal of Medicine
Journal Volume
350
Journal Issue
13
Pages
1304-1313
Date Issued
2004
Author(s)
Abstract
BACKGROUND: We studied the outcomes at school age in children who had participated in a double-blind, placebo-controlled trial of early postnatal dexamethasone therapy (initiated within 12 hours after birth) for the prevention of chronic lung disease of prematurity. METHODS: Of the 262 children included in the initial study, 159 lived to school age. Of these children, 146 (72 in the dexamethasone group and 74 in the control group) were included in our study. All the infants had had severe respiratory distress syndrome requiring mechanical ventilation shortly after birth. In the dexamethasone group, 0.25 mg of dexamethasone per kilogram of body weight was given intravenously every 12 hours for one week, and then the dose was tapered. We evaluated the children's growth, neurologic and motor function, cognition, and school performance. RESULTS: Children in the dexamethasone group were significantly shorter than the controls (P=0.03 for boys, P=0.01 for girls, and P=0.03 for all children) and had a significantly smaller head circumference (P=0.04). Children in the dexamethasone group had significantly poorer motor skills (P<0.001), motor coordination (P<0.001), and visual-motor integration (P=0.02). As compared with the controls, children in the dexamethasone group also had significantly lower full IQ scores (mean [±SD], 78.2±15.0 vs. 84.4±12.6; P=0.008), verbal IQ scores (84.1±13.2 vs. 88.4±11.8, P=0.04), and performance IQ scores (76.5±14.6 vs. 84.5±12.7, P=0.001). The frequency of clinically significant disabilities was higher among children in the dexamethasone group than among controls (28 of 72 [39 percent] vs. 16 of 74 [22 percent], P=0.04). CONCLUSIONS: Early postnatal dexamethasone therapy should not be recommended for the routine prevention or treatment of chronic lung disease, because it leads to substantial adverse effects on neuromotor and cognitive function at school age.
SDGs
Other Subjects
dexamethasone; academic achievement; article; artificial ventilation; body height; chronic lung disease; clinical trial; cognition; cognitive defect; controlled clinical trial; controlled study; disability; female; follow up; growth; head circumference; human; infant; intelligence quotient; major clinical study; male; motor coordination; motor dysfunction; motor performance; neurologic disease; prematurity; priority journal; randomized controlled trial; school child; steroid therapy; treatment outcome; visuomotor coordination; Bronchopulmonary Dysplasia; Child; Chronic Disease; Dexamethasone; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Glucocorticoids; Growth; Humans; Infant, Newborn; Infant, Premature; Infant, Small for Gestational Age; Intelligence; Lung Diseases; Male; Motor Skills; Neurologic Examination; Respiratory Distress Syndrome, Newborn
Type
journal article