Register for email alerts and news feeds:
This journal | BMJ Group
rss
Archives of Disease in Childhood - Fetal and Neonatal Edition 1998;79:F26-F33; doi:10.1136/fn.79.1.F26
Copyright © 1998 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.
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

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.
METHODS---Randomised 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.
RESULTS---Ten 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.
CONCLUSIONS---These 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


© 1998 by Archives of Disease in Childhood

Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

This article has been cited by other articles:

  • Sinha, S. K, Donn, S. M (2006). DIFFICULT EXTUBATION IN BABIES RECEIVING ASSISTED MECHANICAL VENTILATION. EDUCATION AND PRACTICE 91: ep42-ep46 [Full Text]  
  • Finer, N. N., Powers, R. J., Ou, C.-h. S., Durand, D., Wirtschafter, D., Gould, J. B., for the California Perinatal Quality Care Collabor, (2006). Prospective Evaluation of Postnatal Steroid Administration: A 1-Year Experience From the California Perinatal Quality Care Collaborative. Pediatrics 117: 704-713 [Abstract] [Full Text]  
  • Baud, O (2004). Postnatal steroid treatment and brain development. Arch. Dis. Child. Fetal Neonatal Ed. 89: F96-F100 [Abstract] [Full Text]  
  • Ballabh, P, Simm, M, Kumari, J, Krauss, A N, Jain, A, Califano, C, Lesser, M L, Cunningham-Rundles, S (2004). Neutrophil and monocyte adhesion molecules in bronchopulmonary dysplasia, and effects of corticosteroids. Arch. Dis. Child. Fetal Neonatal Ed. 89: F76-F83 [Abstract] [Full Text]  
  • Shinwell, E S, Karplus, M, Bader, D, Dollberg, S, Gur, I, Weintraub, Z, Arnon, S, Gottfreid, E, Zaritsky, A, Makhoul, I R, Reich, D, Sirota, L, Berger, I, Kogan, A, Yurman, S, Goldberg, M, Kohelet, D (2003). Neonatologists are using much less dexamethasone. Arch. Dis. Child. Fetal Neonatal Ed. 88: F432-F433 [Abstract] [Full Text]  
  • Wang, G., Guo, X., Floros, J. (2003). Human SP-A 3'-UTR variants mediate differential gene expression in basal levels and in response to dexamethasone. Am. J. Physiol. Lung Cell. Mol. Physiol. 284: L738-L748 [Abstract] [Full Text]  
  • Armstrong, D L, Penrice, J, Bloomfield, F H, Knight, D B, Dezoete, J A, Harding, J E (2002). Follow up of a randomised trial of two different courses of dexamethasone for preterm babies at risk of chronic lung disease. Arch. Dis. Child. Fetal Neonatal Ed. 86: F102-F107 [Abstract] [Full Text]  
  • Banks, B. A. (2002). Postnatal Dexamethasone for Bronchopulmonary Dysplasia: A Systematic Review and Meta-analysis of 20 Years of Clinical Trials. NeoReviews 3: e24-34 [Full Text]  
  • YADAV, M, BAUMER, J H (2000). To trigger or not to trigger?. Arch. Dis. Child. Fetal Neonatal Ed. 83: 224F-224 [Full Text]  
  • Kavvadia, V, Greenough, A, Dimitriou, G, Hooper, R (2000). Randomised trial of fluid restriction in ventilated very low birthweight infants. Arch. Dis. Child. Fetal Neonatal Ed. 83: 91F-96 [Abstract] [Full Text]  
  • Askin, D. F. (2000). A 42 day tapering course of dexamethasone reduced duration of assisted ventilation in very low birthweight infants, but increased risk of cerebral palsy at age 1 year. Evid. Based Nurs. 3: 41-41 [Full Text]  
  • Sinkin, R. A., Dweck, H. S., Horgan, M. J., Gallaher, K. J., Cox, C., Maniscalco, W. M., Chess, P. R., D'Angio, C. T., Guillet, R., Kendig, J. W., Ryan, R. M., Phelps, D. L. (2000). Early Dexamethasone---Attempting To Prevent Chronic Lung Disease. Pediatrics 105: 542-548 [Abstract] [Full Text]  

This Article

Services
Citing Articles
Google Scholar
PubMed
Topic Collections
Bookmark with

Register for free content

The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Latest from ADC

 

ADC is co-owned by the RCPCH and is the official journal of the European Academy of Paediatrics

BMJ Careers - Latest Paediatrics and Paediatric Surgery Jobs

Paediatrics and Paediatric Surgery Jobs