The use of two or more courses of low-dose systemic dexamethasone to extubate ventilator-dependent preterm neonates may be associated with a higher prevalence of cerebral palsy at two years of corrected age
Our objective was to determine whether the use of two or more courses of low-dose systemic dexamethasone for extubation of ventilator-dependent preterm infants after the first week of life, as proposed in the DART study, is associated with greater neurodevelopmental harm at two years of corrected ag...
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| Veröffentlicht in: | Early human development 2024-07, Vol.194, p.106050, Article 106050 |
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| creator | Rocha, Gustavo Calejo, Rita Arnet, Vanessa de Lima, Filipa Flôr Cassiano, Gonçalo Diogo, Isabel Mesquita, Joana Mimoso, Gabriela Proença, Elisa Carvalho, Carmen Pinto, Constança Gouvêa Salazar, Anabela Aguiar, Marta Silva, Albina Barroso, Almerinda Quintas, Conceição |
| description | Our objective was to determine whether the use of two or more courses of low-dose systemic dexamethasone for extubation of ventilator-dependent preterm infants after the first week of life, as proposed in the DART study, is associated with greater neurodevelopmental harm at two years of corrected age, compared to a single course.
Retrospective review at seven level III neonatal intensive care units. Preterm infants who underwent only one course of systemic dexamethasone for extubation were grouped into DART-1; those who underwent two or more courses were grouped into DART-2. Data and outcomes of infants in DART-2 were compared with those in DART-1.
150 preterm infants were studied: 104 in DART-1 and 46 in DART-2. Patients in DART-2 had a lower gestational age (25 vs. 26 weeks, p = 0.031) and greater morbidity. The average dexamethasone cumulative dose for patients in DART-1 was 0.819 mg/kg, vs. 1.697 mg/kg for patients in DART-2. A total of 14 patients died. The neuromotor and neurosensory assessments at two years of corrected age revealed in the DART-2 survivors, after the multivariate analysis, a higher prevalence of cerebral palsy with functional motor class 2 (OR = 6.837; 95%CI: 1.054–44.337; p = 0.044) and ophthalmological problems requiring the use of glasses (OR = 4.157; 95%CI: 1.026–16.837; p = 0.046).
In this cohort, the use of more than one course of systemic dexamethasone in low doses for extubation of ventilator-dependent premature infants after the first week of life was associated, at two years of corrected age, with a higher prevalence of cerebral palsy with functional motor class 2 and ophthalmological problems requiring the use of glasses.
•Dexamethasone is a powerful anti-inflammatory agent.•Dexamethasone is associated with cerebral palsy in preterm infants.•A low-dose dexamethasone course facilitates extubation of ventilator dependent infants.•It is not known if two courses of dexamethasone for extubation is harmful in preterms.•In our study more than one course of dexamethasone for extubation was harmful. |
| doi_str_mv | 10.1016/j.earlhumdev.2024.106050 |
| format | Article |
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Retrospective review at seven level III neonatal intensive care units. Preterm infants who underwent only one course of systemic dexamethasone for extubation were grouped into DART-1; those who underwent two or more courses were grouped into DART-2. Data and outcomes of infants in DART-2 were compared with those in DART-1.
150 preterm infants were studied: 104 in DART-1 and 46 in DART-2. Patients in DART-2 had a lower gestational age (25 vs. 26 weeks, p = 0.031) and greater morbidity. The average dexamethasone cumulative dose for patients in DART-1 was 0.819 mg/kg, vs. 1.697 mg/kg for patients in DART-2. A total of 14 patients died. The neuromotor and neurosensory assessments at two years of corrected age revealed in the DART-2 survivors, after the multivariate analysis, a higher prevalence of cerebral palsy with functional motor class 2 (OR = 6.837; 95%CI: 1.054–44.337; p = 0.044) and ophthalmological problems requiring the use of glasses (OR = 4.157; 95%CI: 1.026–16.837; p = 0.046).
In this cohort, the use of more than one course of systemic dexamethasone in low doses for extubation of ventilator-dependent premature infants after the first week of life was associated, at two years of corrected age, with a higher prevalence of cerebral palsy with functional motor class 2 and ophthalmological problems requiring the use of glasses.
•Dexamethasone is a powerful anti-inflammatory agent.•Dexamethasone is associated with cerebral palsy in preterm infants.•A low-dose dexamethasone course facilitates extubation of ventilator dependent infants.•It is not known if two courses of dexamethasone for extubation is harmful in preterms.•In our study more than one course of dexamethasone for extubation was harmful.</description><identifier>ISSN: 0378-3782</identifier><identifier>ISSN: 1872-6232</identifier><identifier>EISSN: 1872-6232</identifier><identifier>DOI: 10.1016/j.earlhumdev.2024.106050</identifier><identifier>PMID: 38781715</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Airway Extubation ; Cerebral palsy ; Cerebral Palsy - epidemiology ; Child, Preschool ; Dexamethasone ; Dexamethasone - administration & dosage ; Dexamethasone - adverse effects ; Extubation ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; Male ; Preterm infant ; Prevalence ; Respiration, Artificial ; Retrospective Studies ; Ventilator-dependent</subject><ispartof>Early human development, 2024-07, Vol.194, p.106050, Article 106050</ispartof><rights>2024 Elsevier B.V.</rights><rights>Copyright © 2024 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c319t-4d7cb4a96da7d4d36b21788507eab41abe4559d6a2fe9ad5510175dc3765503</cites><orcidid>0000-0003-3057-6054 ; 0000-0003-4037-4237 ; 0000-0003-1358-0254 ; 0009-0009-6681-3737</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.earlhumdev.2024.106050$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38781715$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rocha, Gustavo</creatorcontrib><creatorcontrib>Calejo, Rita</creatorcontrib><creatorcontrib>Arnet, Vanessa</creatorcontrib><creatorcontrib>de Lima, Filipa Flôr</creatorcontrib><creatorcontrib>Cassiano, Gonçalo</creatorcontrib><creatorcontrib>Diogo, Isabel</creatorcontrib><creatorcontrib>Mesquita, Joana</creatorcontrib><creatorcontrib>Mimoso, Gabriela</creatorcontrib><creatorcontrib>Proença, Elisa</creatorcontrib><creatorcontrib>Carvalho, Carmen</creatorcontrib><creatorcontrib>Pinto, Constança Gouvêa</creatorcontrib><creatorcontrib>Salazar, Anabela</creatorcontrib><creatorcontrib>Aguiar, Marta</creatorcontrib><creatorcontrib>Silva, Albina</creatorcontrib><creatorcontrib>Barroso, Almerinda</creatorcontrib><creatorcontrib>Quintas, Conceição</creatorcontrib><title>The use of two or more courses of low-dose systemic dexamethasone to extubate ventilator-dependent preterm neonates may be associated with a higher prevalence of cerebral palsy at two years of corrected age</title><title>Early human development</title><addtitle>Early Hum Dev</addtitle><description>Our objective was to determine whether the use of two or more courses of low-dose systemic dexamethasone for extubation of ventilator-dependent preterm infants after the first week of life, as proposed in the DART study, is associated with greater neurodevelopmental harm at two years of corrected age, compared to a single course.
Retrospective review at seven level III neonatal intensive care units. Preterm infants who underwent only one course of systemic dexamethasone for extubation were grouped into DART-1; those who underwent two or more courses were grouped into DART-2. Data and outcomes of infants in DART-2 were compared with those in DART-1.
150 preterm infants were studied: 104 in DART-1 and 46 in DART-2. Patients in DART-2 had a lower gestational age (25 vs. 26 weeks, p = 0.031) and greater morbidity. The average dexamethasone cumulative dose for patients in DART-1 was 0.819 mg/kg, vs. 1.697 mg/kg for patients in DART-2. A total of 14 patients died. The neuromotor and neurosensory assessments at two years of corrected age revealed in the DART-2 survivors, after the multivariate analysis, a higher prevalence of cerebral palsy with functional motor class 2 (OR = 6.837; 95%CI: 1.054–44.337; p = 0.044) and ophthalmological problems requiring the use of glasses (OR = 4.157; 95%CI: 1.026–16.837; p = 0.046).
In this cohort, the use of more than one course of systemic dexamethasone in low doses for extubation of ventilator-dependent premature infants after the first week of life was associated, at two years of corrected age, with a higher prevalence of cerebral palsy with functional motor class 2 and ophthalmological problems requiring the use of glasses.
•Dexamethasone is a powerful anti-inflammatory agent.•Dexamethasone is associated with cerebral palsy in preterm infants.•A low-dose dexamethasone course facilitates extubation of ventilator dependent infants.•It is not known if two courses of dexamethasone for extubation is harmful in preterms.•In our study more than one course of dexamethasone for extubation was harmful.</description><subject>Airway Extubation</subject><subject>Cerebral palsy</subject><subject>Cerebral Palsy - epidemiology</subject><subject>Child, Preschool</subject><subject>Dexamethasone</subject><subject>Dexamethasone - administration & dosage</subject><subject>Dexamethasone - adverse effects</subject><subject>Extubation</subject><subject>Female</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infant, Premature</subject><subject>Male</subject><subject>Preterm infant</subject><subject>Prevalence</subject><subject>Respiration, Artificial</subject><subject>Retrospective Studies</subject><subject>Ventilator-dependent</subject><issn>0378-3782</issn><issn>1872-6232</issn><issn>1872-6232</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1v1DAQhiMEotvCX0Bz5JKtncRxcoSKL6kSB3q3JvZs41USL7az2_xJfhPOboEjB2vk0TNf75tlwNmWM17f7reEfujn0dBxW7CiSumaCfYi2_BGFnldlMXLbMNK2eTpFVfZdQh7xphoWvY6uyob2XDJxSb79dATzIHA7SCeHDgPo_ME2s0-UFjTgzvlxiUkLCHSaDUYesKRYo_BTQTRAT3FucNIcKQp2gGj87mhA00m_eHgKZIfYSI3JSjAiAt0BBiC0zZlDJxs7AGht489-bXgiANN-ryWJk-dxwEOOIQFMJ4XXZIC5_W085702gQf6U32apcoevscb7Ifnz893H3N779_-Xb34T7XJW9jXhmpuwrb2qA0lSnrruCyaQSThF3FsaNKiNbUWOyoRSNEUl0Ko0tZC8HKm-z9pevBu58zhahGGzQNA6YT56DKZEbZVFXVJrS5oNq7EDzt1MHbEf2iOFOrl2qv_nmpVi_VxctU-u55ytyNZP4W_jEvAR8vAKVLj5a8Ctquqhm7KqKMs_-f8hvmE7rZ</recordid><startdate>202407</startdate><enddate>202407</enddate><creator>Rocha, Gustavo</creator><creator>Calejo, Rita</creator><creator>Arnet, Vanessa</creator><creator>de Lima, Filipa Flôr</creator><creator>Cassiano, Gonçalo</creator><creator>Diogo, Isabel</creator><creator>Mesquita, Joana</creator><creator>Mimoso, Gabriela</creator><creator>Proença, Elisa</creator><creator>Carvalho, Carmen</creator><creator>Pinto, Constança Gouvêa</creator><creator>Salazar, Anabela</creator><creator>Aguiar, Marta</creator><creator>Silva, Albina</creator><creator>Barroso, Almerinda</creator><creator>Quintas, Conceição</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3057-6054</orcidid><orcidid>https://orcid.org/0000-0003-4037-4237</orcidid><orcidid>https://orcid.org/0000-0003-1358-0254</orcidid><orcidid>https://orcid.org/0009-0009-6681-3737</orcidid></search><sort><creationdate>202407</creationdate><title>The use of two or more courses of low-dose systemic dexamethasone to extubate ventilator-dependent preterm neonates may be associated with a higher prevalence of cerebral palsy at two years of corrected age</title><author>Rocha, Gustavo ; Calejo, Rita ; Arnet, Vanessa ; de Lima, Filipa Flôr ; Cassiano, Gonçalo ; Diogo, Isabel ; Mesquita, Joana ; Mimoso, Gabriela ; Proença, Elisa ; Carvalho, Carmen ; Pinto, Constança Gouvêa ; Salazar, Anabela ; Aguiar, Marta ; Silva, Albina ; Barroso, Almerinda ; Quintas, Conceição</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c319t-4d7cb4a96da7d4d36b21788507eab41abe4559d6a2fe9ad5510175dc3765503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Airway Extubation</topic><topic>Cerebral palsy</topic><topic>Cerebral Palsy - epidemiology</topic><topic>Child, Preschool</topic><topic>Dexamethasone</topic><topic>Dexamethasone - administration & dosage</topic><topic>Dexamethasone - adverse effects</topic><topic>Extubation</topic><topic>Female</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infant, Premature</topic><topic>Male</topic><topic>Preterm infant</topic><topic>Prevalence</topic><topic>Respiration, Artificial</topic><topic>Retrospective Studies</topic><topic>Ventilator-dependent</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rocha, Gustavo</creatorcontrib><creatorcontrib>Calejo, Rita</creatorcontrib><creatorcontrib>Arnet, Vanessa</creatorcontrib><creatorcontrib>de Lima, Filipa Flôr</creatorcontrib><creatorcontrib>Cassiano, Gonçalo</creatorcontrib><creatorcontrib>Diogo, Isabel</creatorcontrib><creatorcontrib>Mesquita, Joana</creatorcontrib><creatorcontrib>Mimoso, Gabriela</creatorcontrib><creatorcontrib>Proença, Elisa</creatorcontrib><creatorcontrib>Carvalho, Carmen</creatorcontrib><creatorcontrib>Pinto, Constança Gouvêa</creatorcontrib><creatorcontrib>Salazar, Anabela</creatorcontrib><creatorcontrib>Aguiar, Marta</creatorcontrib><creatorcontrib>Silva, Albina</creatorcontrib><creatorcontrib>Barroso, Almerinda</creatorcontrib><creatorcontrib>Quintas, Conceição</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Early human development</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rocha, Gustavo</au><au>Calejo, Rita</au><au>Arnet, Vanessa</au><au>de Lima, Filipa Flôr</au><au>Cassiano, Gonçalo</au><au>Diogo, Isabel</au><au>Mesquita, Joana</au><au>Mimoso, Gabriela</au><au>Proença, Elisa</au><au>Carvalho, Carmen</au><au>Pinto, Constança Gouvêa</au><au>Salazar, Anabela</au><au>Aguiar, Marta</au><au>Silva, Albina</au><au>Barroso, Almerinda</au><au>Quintas, Conceição</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The use of two or more courses of low-dose systemic dexamethasone to extubate ventilator-dependent preterm neonates may be associated with a higher prevalence of cerebral palsy at two years of corrected age</atitle><jtitle>Early human development</jtitle><addtitle>Early Hum Dev</addtitle><date>2024-07</date><risdate>2024</risdate><volume>194</volume><spage>106050</spage><pages>106050-</pages><artnum>106050</artnum><issn>0378-3782</issn><issn>1872-6232</issn><eissn>1872-6232</eissn><abstract>Our objective was to determine whether the use of two or more courses of low-dose systemic dexamethasone for extubation of ventilator-dependent preterm infants after the first week of life, as proposed in the DART study, is associated with greater neurodevelopmental harm at two years of corrected age, compared to a single course.
Retrospective review at seven level III neonatal intensive care units. Preterm infants who underwent only one course of systemic dexamethasone for extubation were grouped into DART-1; those who underwent two or more courses were grouped into DART-2. Data and outcomes of infants in DART-2 were compared with those in DART-1.
150 preterm infants were studied: 104 in DART-1 and 46 in DART-2. Patients in DART-2 had a lower gestational age (25 vs. 26 weeks, p = 0.031) and greater morbidity. The average dexamethasone cumulative dose for patients in DART-1 was 0.819 mg/kg, vs. 1.697 mg/kg for patients in DART-2. A total of 14 patients died. The neuromotor and neurosensory assessments at two years of corrected age revealed in the DART-2 survivors, after the multivariate analysis, a higher prevalence of cerebral palsy with functional motor class 2 (OR = 6.837; 95%CI: 1.054–44.337; p = 0.044) and ophthalmological problems requiring the use of glasses (OR = 4.157; 95%CI: 1.026–16.837; p = 0.046).
In this cohort, the use of more than one course of systemic dexamethasone in low doses for extubation of ventilator-dependent premature infants after the first week of life was associated, at two years of corrected age, with a higher prevalence of cerebral palsy with functional motor class 2 and ophthalmological problems requiring the use of glasses.
•Dexamethasone is a powerful anti-inflammatory agent.•Dexamethasone is associated with cerebral palsy in preterm infants.•A low-dose dexamethasone course facilitates extubation of ventilator dependent infants.•It is not known if two courses of dexamethasone for extubation is harmful in preterms.•In our study more than one course of dexamethasone for extubation was harmful.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>38781715</pmid><doi>10.1016/j.earlhumdev.2024.106050</doi><orcidid>https://orcid.org/0000-0003-3057-6054</orcidid><orcidid>https://orcid.org/0000-0003-4037-4237</orcidid><orcidid>https://orcid.org/0000-0003-1358-0254</orcidid><orcidid>https://orcid.org/0009-0009-6681-3737</orcidid></addata></record> |
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| ispartof | Early human development, 2024-07, Vol.194, p.106050, Article 106050 |
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| subjects | Airway Extubation Cerebral palsy Cerebral Palsy - epidemiology Child, Preschool Dexamethasone Dexamethasone - administration & dosage Dexamethasone - adverse effects Extubation Female Humans Infant, Newborn Infant, Premature Male Preterm infant Prevalence Respiration, Artificial Retrospective Studies Ventilator-dependent |
| title | The use of two or more courses of low-dose systemic dexamethasone to extubate ventilator-dependent preterm neonates may be associated with a higher prevalence of cerebral palsy at two years of corrected age |
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