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June 1993, Vol 147, No. 6 >
Article | June 1993

Follow-up of Preterm Infants Treated With Dexamethasone for Chronic Lung Disease FREE

T. Michael O'Shea, MD, MPH; Jamnadas M. Kothadia, MD; Kurt L. Klinepeter, MD; Donald J. Goldstein, PhD; Barbara Jackson, RN, BSN; Robert G. Dillard, MD
[+] Author Affiliations

Accepted for publication December 1, 1992.

Reprint requests to Medical Center Boulevard, Winston-Salem, NC 27157 (Dr O'Shea).


Am J Dis Child. 1993;147(6):658-661. doi:10.1001/archpedi.1993.02160300064024.
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• Objective.  —To study the outcome of prolonged treatment with dexamethasone sodium phosphate in preterm infants who depend on assisted ventilation.

Design.  —Longitudinal follow-up using historic controls.

Setting.  —Regional intensive care nursery.

Participants.  —Sixty-one very-low–birth-weight infants treated with a 42-day course of dexamethasone and 61 historic controls matched for birth weight, gestational age, race, and sex. All 122 subjects required assisted ventilation for at least 15 days.

Intervention.  —Infants were given dexamethasone sodium phosphate at a dose of 0.5 mg/kg per day. The dose was then tapered over 42 days.

Measurements/Main Results.  —Infants treated with dexamethasone received assisted ventilation for a median of 33 days; controls, a median of 47 days (P<.05). One hundred infants survived; 94 were examined at age 1 year. The two groups were similar with respect to the proportions hospitalized for respiratory infection in the first year of life and the proportions with weight, length, and head circumference below the fifth percentile. Rates of cerebral palsy were also similar between the two groups, as were median Bayley Mental and Psychomotor developmental index scores.

Conclusions.  —Dexamethasone treatment was associated with fewer days of assisted ventilation, but not with improved outcome at age 1 year. More assessment should be made of dexamethasone's effect on long-term outcome before dexamethasone becomes widely used in preterm infants who depend on assisted ventilation.(AJDC. 1993;147:658-661)

REFERENCES

1 +
Gladstone IM, Ehrenkranz RA, Jacobs HC.  Pulmonary function tests and fluid balance in neonates with chronic lung disease during dexamethasone treatment . Pediatrics . 1989;;84:1072-1076.
2 +
Yoder MC, Chua R, Tepper R.  Effect of dexamethasone on pulmonary inflammation and pulmonary function of ventilator-dependent infants with bronchopulmonary dysplasia . Am Rev Respir Dis . 1991;;143:1044-1048.
3 +
Cummings JJ, D'Eugeno DB, Gross SJ.  A controlled trial of dexamethasone in preterm infants at high risk for bronchopulmonary dysplasia . N Engl J Med . 1989;;320:1505-1510.
4 +
Harkavy KL, Scanlon JW, Chowdry PK, Grylack LJ.  Dexamethasone therapy for chronic lung disease in ventilator-and oxygen-dependent infants: a controlled trial . J Pediatr . 1989;;115:979-983.
5 +
Kazzi NJ, Brans YW, Poland RL.  Dexamethasone effects on the hospital course of infants with bronchopulmonary dysplasia who are dependent on artificial ventilation . Pediatrics . 1990;;86:722-727.
6 +
Mammel MC, Fiterman C, Coleman M, Boros SJ.  Short-term dexamethasone therapy for bronchopulmonary dysplasia: acute effects and 1-year follow-up . Dev Pharmacol Ther . 1987;;10:1-11.
7 +
Avery GB, Fletcher AB, Kaplan M, Brudno DS.  Controlled trial of dexamethasone in respirator-dependent infants with bronchopulmonary dysplasia . Pediatrics . 1985;;75:106-111.
8 +
Mammel MC, Johnson DE, Green TP, Thompson TR.  Controlled trial of dexamethasone therapy in infants with bronchopulmonary dysplasia . Lancet . 1983;;1:1356-1358.
9 +
Yeh TF, Torre JA, Rastogi A, Anyebuno MA, Pides RS.  Early postnatal dexamethasone therapy in premature infants with severe respiratory distress syndrome: a double-blind, controlled study . J Pediatr . 1990;;117:273-282.
10 +
Wolf YG, Reyna T, Schropp KP, Harmel RP.  Steroid therapy and duodenal ulcer in infants . J Pediatr Gastroenterol Nutr . 1991;;12:269-271.
11 +
O'Neil EA, Chwals WJ, O'Shea MD, Turner CS.  Dexamethasone treatment during ventilator dependency: possible life-threatening gastrointestinal complications . Arch Dis Child . 1992;;67:10-11.
12 +
Ng PC, Brownlee KG, Dear PRF.  Gastroduodenal perforation in preterm babies treated with dexamethasone for bronchopulmonary dysplasia . Arch Dis Child . 1991;;66:1164-1166.
13 +
Noble-Jamieson CM, Regev R, Silverman M.  Dexamethasone in neonatal chronic lung disease: pulmonary effects and intracranial complications . Eur J Pediatr . 1989;;148:365-367.
14 +
Werner JC, Sicard RE, Hansen TWR, Solomon E, Cowett RM, Oh W.  Hypertrophic cardiomyopathy associated with dexamethasone therapy for bronchopulmonary dysplasia . J Pediatr . 1992;;120:286-291.
15 +
Wilson DM, Baldwin RB, Ariagno RL.  A randomized, placebocontrolled trial of effects of dexamethasone on hypothalamic-pituitary-adrenal axis in preterm infants . J Pediatr . 1988;;113:764-768.
16 +
Rizvi ZB, Aniol HS, Myers TF, Zeller WP, Fisher SG, Anderson CL.  Effects of dexamethasone on the hypothalamic-pituitary-adrenal axis in preterm infants . J Pediatr . 1992;;120:961-965.
17 +
Collaborative Dexamethasone Trial Group.  Dexamethasone therapy in neonatal chronic lung disease: an international placebo-controlled trial . Pediatrics . 1991;;88:421-427.
18 +
Ferrara TB, Couser RJ, Hekstra RE.  Side effects and long-term follow-up of corticosteroid therapy in very low birth weight infants with bronchopulmonary dysplasia . J Perinatol . 1990;;10:137-142.
19 +
O'Shea TMD, Dillard RG, Gillis DC, Jackson B, Klinepeter KL.  Outcome at one year in infants with chronic lung disease receiving comprehensive follow-up care: a regional experience in North Carolina, 1984-1990 . N C Med J . 1992;;53:548-554.
20 +
Bayley N. The Bayley Scales of Infant Development . New York, NY: Psychological Corp; 1969;.
21 +
Tibshirani R.  A plain man's guide to the proportional hazards model . Clin Invest Med . 1982;;5:63-68.
22 +
Ng PC, Thomson MA, Dear PRF.  Dexamethasone and infection in preterm babies: a controlled study . Arch Dis Child . 1990;;65:54-58.
23 +
Frank L.  The use of dexamethasone in premature infants at risk for bronchopulmonary dysplasia or who already have developed chronic lung disease: a cautionary note . Pediatrics . 1991;;88:413-414.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Gladstone IM, Ehrenkranz RA, Jacobs HC.  Pulmonary function tests and fluid balance in neonates with chronic lung disease during dexamethasone treatment . Pediatrics . 1989;;84:1072-1076.
2 +
Yoder MC, Chua R, Tepper R.  Effect of dexamethasone on pulmonary inflammation and pulmonary function of ventilator-dependent infants with bronchopulmonary dysplasia . Am Rev Respir Dis . 1991;;143:1044-1048.
3 +
Cummings JJ, D'Eugeno DB, Gross SJ.  A controlled trial of dexamethasone in preterm infants at high risk for bronchopulmonary dysplasia . N Engl J Med . 1989;;320:1505-1510.
4 +
Harkavy KL, Scanlon JW, Chowdry PK, Grylack LJ.  Dexamethasone therapy for chronic lung disease in ventilator-and oxygen-dependent infants: a controlled trial . J Pediatr . 1989;;115:979-983.
5 +
Kazzi NJ, Brans YW, Poland RL.  Dexamethasone effects on the hospital course of infants with bronchopulmonary dysplasia who are dependent on artificial ventilation . Pediatrics . 1990;;86:722-727.
6 +
Mammel MC, Fiterman C, Coleman M, Boros SJ.  Short-term dexamethasone therapy for bronchopulmonary dysplasia: acute effects and 1-year follow-up . Dev Pharmacol Ther . 1987;;10:1-11.
7 +
Avery GB, Fletcher AB, Kaplan M, Brudno DS.  Controlled trial of dexamethasone in respirator-dependent infants with bronchopulmonary dysplasia . Pediatrics . 1985;;75:106-111.
8 +
Mammel MC, Johnson DE, Green TP, Thompson TR.  Controlled trial of dexamethasone therapy in infants with bronchopulmonary dysplasia . Lancet . 1983;;1:1356-1358.
9 +
Yeh TF, Torre JA, Rastogi A, Anyebuno MA, Pides RS.  Early postnatal dexamethasone therapy in premature infants with severe respiratory distress syndrome: a double-blind, controlled study . J Pediatr . 1990;;117:273-282.
10 +
Wolf YG, Reyna T, Schropp KP, Harmel RP.  Steroid therapy and duodenal ulcer in infants . J Pediatr Gastroenterol Nutr . 1991;;12:269-271.
11 +
O'Neil EA, Chwals WJ, O'Shea MD, Turner CS.  Dexamethasone treatment during ventilator dependency: possible life-threatening gastrointestinal complications . Arch Dis Child . 1992;;67:10-11.
12 +
Ng PC, Brownlee KG, Dear PRF.  Gastroduodenal perforation in preterm babies treated with dexamethasone for bronchopulmonary dysplasia . Arch Dis Child . 1991;;66:1164-1166.
13 +
Noble-Jamieson CM, Regev R, Silverman M.  Dexamethasone in neonatal chronic lung disease: pulmonary effects and intracranial complications . Eur J Pediatr . 1989;;148:365-367.
14 +
Werner JC, Sicard RE, Hansen TWR, Solomon E, Cowett RM, Oh W.  Hypertrophic cardiomyopathy associated with dexamethasone therapy for bronchopulmonary dysplasia . J Pediatr . 1992;;120:286-291.
15 +
Wilson DM, Baldwin RB, Ariagno RL.  A randomized, placebocontrolled trial of effects of dexamethasone on hypothalamic-pituitary-adrenal axis in preterm infants . J Pediatr . 1988;;113:764-768.
16 +
Rizvi ZB, Aniol HS, Myers TF, Zeller WP, Fisher SG, Anderson CL.  Effects of dexamethasone on the hypothalamic-pituitary-adrenal axis in preterm infants . J Pediatr . 1992;;120:961-965.
17 +
Collaborative Dexamethasone Trial Group.  Dexamethasone therapy in neonatal chronic lung disease: an international placebo-controlled trial . Pediatrics . 1991;;88:421-427.
18 +
Ferrara TB, Couser RJ, Hekstra RE.  Side effects and long-term follow-up of corticosteroid therapy in very low birth weight infants with bronchopulmonary dysplasia . J Perinatol . 1990;;10:137-142.
19 +
O'Shea TMD, Dillard RG, Gillis DC, Jackson B, Klinepeter KL.  Outcome at one year in infants with chronic lung disease receiving comprehensive follow-up care: a regional experience in North Carolina, 1984-1990 . N C Med J . 1992;;53:548-554.
20 +
Bayley N. The Bayley Scales of Infant Development . New York, NY: Psychological Corp; 1969;.
21 +
Tibshirani R.  A plain man's guide to the proportional hazards model . Clin Invest Med . 1982;;5:63-68.
22 +
Ng PC, Thomson MA, Dear PRF.  Dexamethasone and infection in preterm babies: a controlled study . Arch Dis Child . 1990;;65:54-58.
23 +
Frank L.  The use of dexamethasone in premature infants at risk for bronchopulmonary dysplasia or who already have developed chronic lung disease: a cautionary note . Pediatrics . 1991;;88:413-414.

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