Arch Dis Child Fetal Neonatal Ed 2000;83:F177-F181 ( November )

Early postnatal dexamethasone treatment and increased incidence of cerebral palsy

E S Shinwell^a, M Karplus^b, D Reich^c, Z Weintraub^d, S Blazer^e, D Bader^f, S Yurman^g, T Dolfin^h, A Koganⁱ, S Dollberg^j, E Arbel^k, M Goldberg^l, I Gur^m, N Naorⁿ, L Sirotaⁿ, S Mogilner^a, A Zaritsky^o, M Barak^p, E Gottfried^q

^a Kaplan Medical Center, Rechovot, Israel, ^b Soroka Medical Center, Beersheva, ^c Ha'emek Medical Center, Afula, ^d Carmel Medical Center, Haifa, ^e Rambam Medical Center, Haifa, ^f Bnei-Zion Medical Center, Haifa, ^g Hillel Yaffe Medical Center, Hadera, ^h Meir Medical Center, Kfar Saba, ⁱ Sheba Medical Center, Tel Hashomer, ^j Tel Aviv Medical Center, Tel Aviv, ^k Wolfson Medical Center, Holon, ^l Assaf Harofe Medical Center, Tsrifin, ^m Bikur Holim Medical Center, Jerusalem, ⁿ Beilinson Medical Center, Petach Tikva, ^o Barzilai Medical Center, Ashkelon, ^p Nahariya Regional Medical Center, ^q Rivka Ziv Medical Center, Tsfat

Correspondence to: Dr Shinwell, Department of Neonatology, Kaplan Medical Center, Rechovot, Israel shinwell{at}netvision.net.il

Accepted 14 June 2000

OBJECTIVETo study the long term neurodevelopmental outcome of children who participated in a randomised, double blind, placebo controlled study of early postnatal dexamethasone treatment for prevention of chronic lung disease.
METHODSThe original study compared a three day course of dexamethasone (n = 132) with a saline placebo (n = 116) administered from before 12 hours of age in preterm infants, who were ventilated for respiratory distress syndrome and had received surfactant treatment. Dexamethasone treatment was associated with an increased incidence of hypertension, hyperglycaemia, and gastrointestinal haemorrhage and no reduction in either the incidence or severity of chronic lung disease or mortality. A total of 195 infants survived to discharge and five died later. Follow up data were obtained on 159 of 190 survivors at a mean (SD) age of 53 (18) months.
RESULTSNo differences were found between the groups in terms of perinatal or neonatal course, antenatal steroid administration, severity of initial disease, or major neonatal morbidity. Dexamethasone treated children had a significantly higher incidence of cerebral palsy than those receiving placebo (39/80 (49%) v 12/79 (15%) respectively; odds ratio (OR) 4.62, 95% confidence interval (95% CI) 2.38 to 8.98). The most common form of cerebral palsy was spastic diplegia (incidence 22/80 (28%) v 5/79 (6%) in dexamethasone and placebo treated infants respectively; OR 4.45, 95% CI 1.95 to 10.15). Developmental delay was significantly more common in the dexamethasone treated group (44/80 (55%)) than in the placebo treated group (23/79 (29%); OR 2.87, 95% CI 1.53 to 5.38). Dexamethasone treated infants had more periventricular leucomalacia and less intraventricular haemorrhage in the neonatal period than those in the placebo group, although these differences were not statistically significant. Eleven children with cerebral palsy had normal ultrasound scans in the neonatal period; all 11 had received dexamethasone. Logistic regression analysis showed both periventricular leucomalacia and drug assignment to dexamethasone to be highly significant predictors of abnormal neurological outcome.
CONCLUSIONSA three day course of dexamethasone administered shortly after birth in preterm infants with respiratory distress syndrome is associated with a significantly increased incidence of cerebral palsy and developmental delay.


Keywords: dexamethasone; steroids; chronic lung disease; bronchopulmonary dysplasia; cerebral palsy

---

© 2000 by Archives of Disease in Childhood
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Korvenranta, E., Lehtonen, L., Peltola, M., Hakkinen, U., Andersson, S., Gissler, M., Hallman, M., Leipala, J., Rautava, L., Tammela, O., Linna, M. (2009). Morbidities and Hospital Resource Use During the First 3 Years of Life Among Very Preterm Infants. Pediatrics 124: 128-134 [Abstract] [Full Text]  
• Anjari, M., Counsell, S. J., Srinivasan, L., Allsop, J. M., Hajnal, J. V., Rutherford, M. A., Edwards, A. D. (2009). The Association of Lung Disease With Cerebral White Matter Abnormalities in Preterm Infants. Pediatrics 124: 268-276 [Abstract] [Full Text]  
• Wilson-Costello, D., Walsh, M. C., Langer, J. C., Guillet, R., Laptook, A. R., Stoll, B. J., Shankaran, S., Finer, N. N., Van Meurs, K. P., Engle, W. A., Das, A., for the Eunice Kennedy Shriver National Institute, (2009). Impact of Postnatal Corticosteroid Use on Neurodevelopment at 18 to 22 Months' Adjusted Age: Effects of Dose, Timing, and Risk of Bronchopulmonary Dysplasia in Extremely Low Birth Weight Infants. Pediatrics 123: e430-e437 [Abstract] [Full Text]  
• de Vries, W. B., Karemaker, R., Mooy, N. F., Strengers, J. L. M., Kemperman, H., Baerts, W., Veen, S., Visser, G. H. A., Heijnen, C. J., van Bel, F. (2008). Cardiovascular Follow-up at School Age After Perinatal Glucocorticoid Exposure in Prematurely Born Children: Perinatal Glucocorticoid Therapy and Cardiovascular Follow-up. Arch Pediatr Adolesc Med 162: 738-744 [Abstract] [Full Text]  
• Eelloo, J A, Roberts, S A, Emmerson, A J B, Ward, K A, Adams, J E, Mughal, M Z (2008). Bone status of children aged 5-8 years, treated with dexamethasone for chronic lung disease of prematurity. Arch. Dis. Child. Fetal Neonatal Ed. 93: F222-F224 [Abstract] [Full Text]  
• Karemaker, R., Kavelaars, A., ter Wolbeek, M., Tersteeg-Kamperman, M., Baerts, W., Veen, S., Samsom, J. F., Visser, G. H. A., van Bel, F., Heijnen, C. J. (2008). Neonatal Dexamethasone Treatment for Chronic Lung Disease of Prematurity Alters the Hypothalamus-Pituitary-Adrenal Axis and Immune System Activity at School Age. Pediatrics 121: e870-e878 [Abstract] [Full Text]  
• Kobaly, K., Schluchter, M., Minich, N., Friedman, H., Taylor, H. G., Wilson-Costello, D., Hack, M. (2008). Outcomes of Extremely Low Birth Weight (<1 kg) and Extremely Low Gestational Age (<28 Weeks) Infants With Bronchopulmonary Dysplasia: Effects of Practice Changes in 2000 to 2003. Pediatrics 121: 73-81 [Abstract] [Full Text]  
• Rademaker, K J, de Vries, L S, Uiterwaal, C S P M, Groenendaal, F, Grobbee, D E, van Bel, F (2008). Postnatal hydrocortisone treatment for chronic lung disease in the preterm newborn and long-term neurodevelopmental follow-up. Arch. Dis. Child. Fetal Neonatal Ed. 93: F58-F63 [Abstract] [Full Text]  
• Wapner, R. J., Sorokin, Y., Mele, L., Johnson, F., Dudley, D. J., Spong, C. Y., Peaceman, A. M., Leveno, K. J., Malone, F., Caritis, S. N., Mercer, B., Harper, M., Rouse, D. J., Thorp, J. M., Ramin, S., Carpenter, M. W., Gabbe, S. G., the National Institute of Child Health and Human D, (2007). Long-Term Outcomes after Repeat Doses of Antenatal Corticosteroids. NEJM 357: 1190-1198 [Abstract] [Full Text]  
• O'Shea, T. M., Washburn, L. K., Nixon, P. A., Goldstein, D. J. (2007). Follow-up of a Randomized, Placebo-Controlled Trial of Dexamethasone to Decrease the Duration of Ventilator Dependency in Very Low Birth Weight Infants: Neurodevelopmental Outcomes at 4 to 11 Years of Age. Pediatrics 120: 594-602 [Abstract] [Full Text]  
• Doyle, L. W., Davis, P. G., Morley, C. J., McPhee, A., Carlin, J. B., and the DART Study Investigators, (2007). Outcome at 2 Years of Age of Infants From the DART Study: A Multicenter, International, Randomized, Controlled Trial of Low-Dose Dexamethasonef. Pediatrics 119: 716-721 [Abstract] [Full Text]  
• Shinwell, E S, Lerner-Geva, L, Lusky, A, Reichman, B, in collaboration with the Israel Neonatal Network, (2007). Less postnatal steroids, more bronchopulmonary dysplasia: a population-based study in very low birthweight infants. Arch. Dis. Child. Fetal Neonatal Ed. 92: F30-F33 [Abstract] [Full Text]  
• Wilson, T. T., Waters, L., Patterson, C. C., McCusker, C. G., Rooney, N. M., Marlow, N., Halliday, H. L. (2006). Neurodevelopmental and Respiratory Follow-up Results at 7 Years for Children From the United Kingdom and Ireland Enrolled in a Randomized Trial of Early and Late Postnatal Corticosteroid Treatment, Systemic and Inhaled (the Open Study of Early Corticosteroid Treatment).. Pediatrics 117: 2196-2205 [Abstract] [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]  
• Christou, H., Brodsky, D. (2005). Lung Injury and Bronchopulmonary Dysplasia in Newborn Infants. J Intensive Care Med 20: 76-87 [Abstract]  
• Neal, C. R. Jr., Weidemann, G., Kabbaj, M., Vazquez, D. M. (2004). Effect of neonatal dexamethasone exposure on growth and neurological development in the adult rat. Am. J. Physiol. Regul. Integr. Comp. Physiol. 287: R375-R385 [Abstract] [Full Text]  
• Yeh, T. F., Lin, Y. J., Lin, H. C., Huang, C. C., Hsieh, W. S., Lin, C. H., Tsai, C. H. (2004). Outcomes at School Age after Postnatal Dexamethasone Therapy for Lung Disease of Prematurity. NEJM 350: 1304-1313 [Abstract] [Full Text]  
• Baud, O (2004). Postnatal steroid treatment and brain development. Arch. Dis. Child. Fetal Neonatal Ed. 89: F96-F100 [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]  
• Counsell, S J, Rutherford, M A, Cowan, F M, Edwards, A D (2003). Magnetic resonance imaging of preterm brain injury. Arch. Dis. Child. Fetal Neonatal Ed. 88: F269-F274 [Abstract] [Full Text]  
• Romagnoli, C, Zecca, E, Luciano, R, Torrioli, G, Tortorolo, G (2002). A three year follow up of preterm infants after moderately early treatment with dexamethasone. Arch. Dis. Child. Fetal Neonatal Ed. 87: F55-58 [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]  
• TARNOW-MORDI, W (2001). Dexamethasone, survival, and neurological impairment. Arch. Dis. Child. 85: 268e-268 [Full Text]  
• PHAROAH, P O D (2001). Dexamethasone treatment and cerebral palsy. Arch. Dis. Child. Fetal Neonatal Ed. 84: 140F-140 [Full Text]  

eLetters:

Read all eLetters

Dexamethasone treatment and cerebral palsy

POD Pharoah

Fetal Neonatal Ed. Online, 8 Nov 2000 [Full text]

Re: Dexamethasone treatment and cerebral palsy

Eric S Shinwell

Fetal Neonatal Ed. Online, 22 Nov 2000 [Full text]