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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
OBJECTIVE
To 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.
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