Background We studied the outcomes at school age in childrenwho had participated in a double-blind, placebo-controlled trialof early postnatal dexamethasone therapy (initiated within 12hours after birth) for the prevention of chronic lung diseaseof prematurity.
Methods Of the 262 children included in the initial study, 159lived to school age. Of these children, 146 (72 in the dexamethasonegroup and 74 in the control group) were included in our study.All the infants had had severe respiratory distress syndromerequiring mechanical ventilation shortly after birth. In thedexamethasone group, 0.25 mg of dexamethasone per kilogram ofbody weight was given intravenously every 12 hours for one week,and then the dose was tapered. We evaluated the children's growth,neurologic and motor function, cognition, and school performance.
Results Children in the dexamethasone group were significantlyshorter than the controls (P=0.03 for boys, P=0.01 for girls,and P=0.03 for all children) and had a significantly smallerhead circumference (P=0.04). Children in the dexamethasone grouphad significantly poorer motor skills (P<0.001), motor coordination(P<0.001), and visual–motor integration (P=0.02). Ascompared with the controls, children in the dexamethasone groupalso had significantly lower full IQ scores (mean [±SD],78.2±15.0 vs. 84.4±12.6; P=0.008), verbal IQ scores(84.1±13.2 vs. 88.4±11.8, P=0.04), and performanceIQ scores (76.5±14.6 vs. 84.5±12.7, P=0.001).The frequency of clinically significant disabilities was higheramong children in the dexamethasone group than among controls(28 of 72 [39 percent] vs. 16 of 74 [22 percent], P=0.04).
Conclusions Early postnatal dexamethasone therapy should notbe recommended for the routine prevention or treatment of chroniclung disease, because it leads to substantial adverse effectson neuromotor and cognitive function at school age.
Source Information
From the Department of Pediatrics, China Medical University, Taichung (T.F.Y., H.C.L.); the National Chung-Kung University Hospital, Tainan (Y.J.L., C.C.H., C.H.L., C.H.T.); and the National Taiwan University Hospital, Taipei (W.S.H.) — all in Taiwan.
Address reprint requests to Dr. Yeh at the Department of Pediatrics, College of Medicine, China Medical Univeristy, 91 Hsueh-Shih Rd., Taichung 40421, Taiwan, or at master{at}mail.cmu.edu.tw.
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