Arch Dis Child Fetal Neonatal Ed 1998;79:F26-F33 ( July )

Systematic review and meta-analysis of early postnatal dexamethasone for prevention of chronic lung disease

Tushar Bhuta, Arne Ohlsson

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

AIMTo 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.

Key messages Early postnatal dexamethasone begun within 14 days of age significantly reduces the risk of CLD at 28 days and 36 weeks of postmenstrual age When started between 7 and 14 days of age there is also a significant reduction in mortality. Significant side effects include increased risk of hypertension, hyperglycaemia, and increased time to regain birthweight There are no data on long term neurodevelopmental outcomes

Keywords: dexamethasone; chronic lung disease; prevention; meta-analysis; randomised controlled trials

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© 1998 by Archives of Disease in Childhood
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