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Shared Program in Neonatology, University
of Toronto, Ontario, Canada
Correspondence to: Dr Arne Ohlsson Department of Newborn and Developmental Paediatrics Women's College Hospital 76 Grenville Street, Toronto, Ontario Canada M5G1B2. Email: aohlsson{at}globalserve.net
Accepted 26 January
1998
AIM
To review
systematically the evidence to determine whether dexamethasone
treatment of very low birthweight infants begun within 14 days of age
prevents chronic lung disease (CLD) without clinically significant side effects.
METHODSRandomised
controlled trials of dexamethasone started within this time frame were
identified through a search of electronic databases, proceedings of
scientific meetings, and personal files. Meta-analyses using event rate
ratio (ERR), event rate difference (ERD), and if significant, numbers
needed to treat (NNT) for benefits and numbers needed to harm (NNH) for
adverse effects were calculated. Weighted mean difference were used for
continuous variables. Three prespecified subgroup analyses were
performed for; (i) dexamethasone begun within 36 hours (hours) of
birth; (ii) dexamethasone initiated between 7-14 days of age; or (iii)
if surfactant treatment was used.
RESULTSTen studies
were included in the review; six where dexamethasone was initiated
within 36 hours of age, four studies for dexamethasone started between
7 and 14 days and six studies using surfactant. Mortality ERR and NNT
with 95% confidence intervals for dexamethasone initiated at 7-14
days of age were 0.35 (0.16, 0.74) and 8 (4, 30). ERRs and NNTs for CLD
at 28 days and 36 weeks of postmenstrual age were 0.71 (0.61, 0.84), 8 (5, 17), and 0.57 (0.44, 0.76), 10 (6, 23) in the overall analyses.
When dexamethasone was started at 7 to 14 days of age ERR and NNT for
CLD at 36 weeks were 0.63 (0.47, 0.85) and 3 (2, 9). Clinically
significant side effects included increased risk of hypertension,
hyperglycaemia, and increased time to regain birthweight.
CONCLUSIONSThese
meta-analyses show a significant reduction in risk of CLD at 28 days
and 36 weeks of postmenstrual age. In the subgroup where dexamethasone
was started between 7 and 14 days of age mortality was significantly
reduced. Caution is warranted in the routine use of dexamethasone
because of lack of data on long term neurodevelopmental outcomes.
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