Follow-up at 15 Years of Preterm Infants From a Controlled Trial of Moderately Early Dexamethasone for the Prevention of Chronic Lung Disease
Postnatal dexamethasone treatment of ventilator-dependent preterm infants results in rapid improvement in lung function and reduction in chronic lung disease. However, limited data are available on long-term outcomes after such therapy. We studied growth, neurodevelopmental, and pulmonary outcomes a...
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| Veröffentlicht in: | Pediatrics (Evanston) 2005-03, Vol.115 (3), p.681-687 |
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| description | Postnatal dexamethasone treatment of ventilator-dependent preterm infants results in rapid improvement in lung function and reduction in chronic lung disease. However, limited data are available on long-term outcomes after such therapy. We studied growth, neurodevelopmental, and pulmonary outcomes at adolescence in children who had participated in a double-blind, placebo-controlled trial of dexamethasone beginning at 2 weeks of age for the prevention of chronic lung disease.
Thirty-six infants (birth weight < or =1250 g and gestational age < or =30 weeks) who were dependent on mechanical ventilation at 2 weeks of age received a 42-day course of dexamethasone, an 18-day course of dexamethasone, or saline placebo. Twenty-two children survived to 15 years (69% of the 42-day dexamethasone group, 67% of the 18-day dexamethasone group and 45% of the control group), and all were evaluated. Intact survival was defined as survival with normal neurologic examination, IQ >70, and receiving education in the regular classroom.
There were no differences among groups for growth or incidence of neurologic abnormalities. The mean IQ for the 42-day dexamethasone group was 85 +/- 10 compared with 60 +/- 20 for the 18-day dexamethasone group and 73 +/- 23 for the control group. All children in the 42-day dexamethasone group were receiving education in the regular classroom compared with only 50% of the 18-day dexamethasone group and 40% of the control group. As a result, intact survival was significantly greater for the 42-day dexamethasone group (69%) than for either the 18-day dexamethasone group (25%) or the control group (18%). Pulmonary function was significantly better for the 42-day dexamethasone group compared with the 18-day dexamethasone group (eg, forced expiratory volume in 1 second: 90 +/- 16 vs 71 +/- 15% predicted, respectively).
A 42-day course of dexamethasone therapy beginning at 2 weeks of age in preterm infants who are at high risk for severe chronic lung disease was associated with improved long-term neurodevelopmental outcome. Although additional research is needed to establish the optimal steroid preparation, dosage, and duration of therapy, these data support the view that moderately early (beginning at 1-2 weeks) corticosteroid treatment is advantageous for a select group of ventilator-dependent preterm infants. |
| doi_str_mv | 10.1542/peds.2004-0956 |
| format | Article |
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Thirty-six infants (birth weight < or =1250 g and gestational age < or =30 weeks) who were dependent on mechanical ventilation at 2 weeks of age received a 42-day course of dexamethasone, an 18-day course of dexamethasone, or saline placebo. Twenty-two children survived to 15 years (69% of the 42-day dexamethasone group, 67% of the 18-day dexamethasone group and 45% of the control group), and all were evaluated. Intact survival was defined as survival with normal neurologic examination, IQ >70, and receiving education in the regular classroom.
There were no differences among groups for growth or incidence of neurologic abnormalities. The mean IQ for the 42-day dexamethasone group was 85 +/- 10 compared with 60 +/- 20 for the 18-day dexamethasone group and 73 +/- 23 for the control group. All children in the 42-day dexamethasone group were receiving education in the regular classroom compared with only 50% of the 18-day dexamethasone group and 40% of the control group. As a result, intact survival was significantly greater for the 42-day dexamethasone group (69%) than for either the 18-day dexamethasone group (25%) or the control group (18%). Pulmonary function was significantly better for the 42-day dexamethasone group compared with the 18-day dexamethasone group (eg, forced expiratory volume in 1 second: 90 +/- 16 vs 71 +/- 15% predicted, respectively).
A 42-day course of dexamethasone therapy beginning at 2 weeks of age in preterm infants who are at high risk for severe chronic lung disease was associated with improved long-term neurodevelopmental outcome. Although additional research is needed to establish the optimal steroid preparation, dosage, and duration of therapy, these data support the view that moderately early (beginning at 1-2 weeks) corticosteroid treatment is advantageous for a select group of ventilator-dependent preterm infants.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2004-0956</identifier><identifier>PMID: 15741372</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>Elk Grove Village, IL: Am Acad Pediatrics</publisher><subject>Adolescent ; Anti-Inflammatory Agents - administration & dosage ; Artificial respiration ; Biological and medical sciences ; Bronchopulmonary Dysplasia - prevention & control ; Chronic Disease ; Clinical trials ; Comparative analysis ; Complications and side effects ; Dexamethasone ; Dexamethasone - administration & dosage ; Drug therapy ; Education, Special ; Follow-Up Studies ; General aspects ; Growth - drug effects ; Health aspects ; Humans ; Infant, Newborn ; Infant, Premature ; Infants (Premature) ; Intelligence - drug effects ; Lung diseases ; Mechanical ventilation ; Medical sciences ; Neurologic Examination ; Patient outcomes ; Pediatrics ; Premature infants ; Pulmonary Ventilation - drug effects ; Respiration, Artificial ; Respiratory diseases ; Respiratory Distress Syndrome, Newborn - drug therapy ; Respiratory Distress Syndrome, Newborn - mortality ; Steroids ; Teenagers ; Treatment Outcome ; Youth</subject><ispartof>Pediatrics (Evanston), 2005-03, Vol.115 (3), p.681-687</ispartof><rights>2005 INIST-CNRS</rights><rights>COPYRIGHT 2005 American Academy of Pediatrics</rights><rights>Copyright American Academy of Pediatrics Mar 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c427t-f79da4ba4f370afc76a4bad5cc8d95c7506914911e10f2adcbea454e529a75483</citedby><cites>FETCH-LOGICAL-c427t-f79da4ba4f370afc76a4bad5cc8d95c7506914911e10f2adcbea454e529a75483</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16582222$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15741372$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gross, Steven J</creatorcontrib><creatorcontrib>Anbar, Ran D</creatorcontrib><creatorcontrib>Mettelman, Barbara B</creatorcontrib><title>Follow-up at 15 Years of Preterm Infants From a Controlled Trial of Moderately Early Dexamethasone for the Prevention of Chronic Lung Disease</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>Postnatal dexamethasone treatment of ventilator-dependent preterm infants results in rapid improvement in lung function and reduction in chronic lung disease. However, limited data are available on long-term outcomes after such therapy. We studied growth, neurodevelopmental, and pulmonary outcomes at adolescence in children who had participated in a double-blind, placebo-controlled trial of dexamethasone beginning at 2 weeks of age for the prevention of chronic lung disease.
Thirty-six infants (birth weight < or =1250 g and gestational age < or =30 weeks) who were dependent on mechanical ventilation at 2 weeks of age received a 42-day course of dexamethasone, an 18-day course of dexamethasone, or saline placebo. Twenty-two children survived to 15 years (69% of the 42-day dexamethasone group, 67% of the 18-day dexamethasone group and 45% of the control group), and all were evaluated. Intact survival was defined as survival with normal neurologic examination, IQ >70, and receiving education in the regular classroom.
There were no differences among groups for growth or incidence of neurologic abnormalities. The mean IQ for the 42-day dexamethasone group was 85 +/- 10 compared with 60 +/- 20 for the 18-day dexamethasone group and 73 +/- 23 for the control group. All children in the 42-day dexamethasone group were receiving education in the regular classroom compared with only 50% of the 18-day dexamethasone group and 40% of the control group. As a result, intact survival was significantly greater for the 42-day dexamethasone group (69%) than for either the 18-day dexamethasone group (25%) or the control group (18%). Pulmonary function was significantly better for the 42-day dexamethasone group compared with the 18-day dexamethasone group (eg, forced expiratory volume in 1 second: 90 +/- 16 vs 71 +/- 15% predicted, respectively).
A 42-day course of dexamethasone therapy beginning at 2 weeks of age in preterm infants who are at high risk for severe chronic lung disease was associated with improved long-term neurodevelopmental outcome. Although additional research is needed to establish the optimal steroid preparation, dosage, and duration of therapy, these data support the view that moderately early (beginning at 1-2 weeks) corticosteroid treatment is advantageous for a select group of ventilator-dependent preterm infants.</description><subject>Adolescent</subject><subject>Anti-Inflammatory Agents - administration & dosage</subject><subject>Artificial respiration</subject><subject>Biological and medical sciences</subject><subject>Bronchopulmonary Dysplasia - prevention & control</subject><subject>Chronic Disease</subject><subject>Clinical trials</subject><subject>Comparative analysis</subject><subject>Complications and side effects</subject><subject>Dexamethasone</subject><subject>Dexamethasone - administration & dosage</subject><subject>Drug therapy</subject><subject>Education, Special</subject><subject>Follow-Up Studies</subject><subject>General aspects</subject><subject>Growth - drug effects</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infant, Premature</subject><subject>Infants (Premature)</subject><subject>Intelligence - drug effects</subject><subject>Lung diseases</subject><subject>Mechanical ventilation</subject><subject>Medical sciences</subject><subject>Neurologic Examination</subject><subject>Patient outcomes</subject><subject>Pediatrics</subject><subject>Premature infants</subject><subject>Pulmonary Ventilation - drug effects</subject><subject>Respiration, Artificial</subject><subject>Respiratory diseases</subject><subject>Respiratory Distress Syndrome, Newborn - drug therapy</subject><subject>Respiratory Distress Syndrome, Newborn - mortality</subject><subject>Steroids</subject><subject>Teenagers</subject><subject>Treatment Outcome</subject><subject>Youth</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkUtvEzEUhUcIRENhyxJZSLCbYHvseSyrtIFKRWVRFqysG8-dxNWMHWxPHz-C_4ytRArCCz-k7557fE9RvGd0yaTgX_bYhyWnVJS0k_WLYsFo15aCN_JlsaC0YqWgVJ4Vb0K4pwmTDX9dnDHZCFY1fFH8WbtxdI_lvCcQCZPkF4IPxA3kh8eIfiLXdgAbA1l7NxEgK2ejTzXYkztvYMzod9ejh4jjM7kCn_ZLfIIJ4w6Cs0gG50ncYVZ8QBuNs7lotfPOGk1uZrsllyYgBHxbvBpgDPjueJ4XP9dXd6tv5c3t1-vVxU2p089iOTRdD2IDYqgaCoNu6vzqpdZt30ndSFp3THSMIaMDh15vEIQUKHkHjRRtdV58Pujuvfs9Y4hqMkHjOIJFNwdVN6LlgrEEfvwPvHezt8mb4rytEtRltfIAbWFEZaxOI8KnqPOUtqiS89WtumAV7SomhEj88sBr70LwOKi9NxP4Z8WoyqmqnKrKqaqcair4cHQxbybsT_gxxgR8OgIQNIyDB6tNOHG1bHlap847s909Go-5k4HojQ7_XBmTqlJ1y6q_z9q60Q</recordid><startdate>20050301</startdate><enddate>20050301</enddate><creator>Gross, Steven J</creator><creator>Anbar, Ran D</creator><creator>Mettelman, Barbara B</creator><general>Am Acad Pediatrics</general><general>American Academy of Pediatrics</general><scope>IQODW</scope><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>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20050301</creationdate><title>Follow-up at 15 Years of Preterm Infants From a Controlled Trial of Moderately Early Dexamethasone for the Prevention of Chronic Lung Disease</title><author>Gross, Steven J ; Anbar, Ran D ; Mettelman, Barbara B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c427t-f79da4ba4f370afc76a4bad5cc8d95c7506914911e10f2adcbea454e529a75483</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adolescent</topic><topic>Anti-Inflammatory Agents - administration & dosage</topic><topic>Artificial respiration</topic><topic>Biological and medical sciences</topic><topic>Bronchopulmonary Dysplasia - prevention & control</topic><topic>Chronic Disease</topic><topic>Clinical trials</topic><topic>Comparative analysis</topic><topic>Complications and side effects</topic><topic>Dexamethasone</topic><topic>Dexamethasone - administration & dosage</topic><topic>Drug therapy</topic><topic>Education, Special</topic><topic>Follow-Up Studies</topic><topic>General aspects</topic><topic>Growth - drug effects</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infant, Premature</topic><topic>Infants (Premature)</topic><topic>Intelligence - drug effects</topic><topic>Lung diseases</topic><topic>Mechanical ventilation</topic><topic>Medical sciences</topic><topic>Neurologic Examination</topic><topic>Patient outcomes</topic><topic>Pediatrics</topic><topic>Premature infants</topic><topic>Pulmonary Ventilation - drug effects</topic><topic>Respiration, Artificial</topic><topic>Respiratory diseases</topic><topic>Respiratory Distress Syndrome, Newborn - drug therapy</topic><topic>Respiratory Distress Syndrome, Newborn - mortality</topic><topic>Steroids</topic><topic>Teenagers</topic><topic>Treatment Outcome</topic><topic>Youth</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gross, Steven J</creatorcontrib><creatorcontrib>Anbar, Ran D</creatorcontrib><creatorcontrib>Mettelman, Barbara B</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gross, Steven J</au><au>Anbar, Ran D</au><au>Mettelman, Barbara B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Follow-up at 15 Years of Preterm Infants From a Controlled Trial of Moderately Early Dexamethasone for the Prevention of Chronic Lung Disease</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2005-03-01</date><risdate>2005</risdate><volume>115</volume><issue>3</issue><spage>681</spage><epage>687</epage><pages>681-687</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>Postnatal dexamethasone treatment of ventilator-dependent preterm infants results in rapid improvement in lung function and reduction in chronic lung disease. However, limited data are available on long-term outcomes after such therapy. We studied growth, neurodevelopmental, and pulmonary outcomes at adolescence in children who had participated in a double-blind, placebo-controlled trial of dexamethasone beginning at 2 weeks of age for the prevention of chronic lung disease.
Thirty-six infants (birth weight < or =1250 g and gestational age < or =30 weeks) who were dependent on mechanical ventilation at 2 weeks of age received a 42-day course of dexamethasone, an 18-day course of dexamethasone, or saline placebo. Twenty-two children survived to 15 years (69% of the 42-day dexamethasone group, 67% of the 18-day dexamethasone group and 45% of the control group), and all were evaluated. Intact survival was defined as survival with normal neurologic examination, IQ >70, and receiving education in the regular classroom.
There were no differences among groups for growth or incidence of neurologic abnormalities. The mean IQ for the 42-day dexamethasone group was 85 +/- 10 compared with 60 +/- 20 for the 18-day dexamethasone group and 73 +/- 23 for the control group. All children in the 42-day dexamethasone group were receiving education in the regular classroom compared with only 50% of the 18-day dexamethasone group and 40% of the control group. As a result, intact survival was significantly greater for the 42-day dexamethasone group (69%) than for either the 18-day dexamethasone group (25%) or the control group (18%). Pulmonary function was significantly better for the 42-day dexamethasone group compared with the 18-day dexamethasone group (eg, forced expiratory volume in 1 second: 90 +/- 16 vs 71 +/- 15% predicted, respectively).
A 42-day course of dexamethasone therapy beginning at 2 weeks of age in preterm infants who are at high risk for severe chronic lung disease was associated with improved long-term neurodevelopmental outcome. Although additional research is needed to establish the optimal steroid preparation, dosage, and duration of therapy, these data support the view that moderately early (beginning at 1-2 weeks) corticosteroid treatment is advantageous for a select group of ventilator-dependent preterm infants.</abstract><cop>Elk Grove Village, IL</cop><pub>Am Acad Pediatrics</pub><pmid>15741372</pmid><doi>10.1542/peds.2004-0956</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Anti-Inflammatory Agents - administration & dosage Artificial respiration Biological and medical sciences Bronchopulmonary Dysplasia - prevention & control Chronic Disease Clinical trials Comparative analysis Complications and side effects Dexamethasone Dexamethasone - administration & dosage Drug therapy Education, Special Follow-Up Studies General aspects Growth - drug effects Health aspects Humans Infant, Newborn Infant, Premature Infants (Premature) Intelligence - drug effects Lung diseases Mechanical ventilation Medical sciences Neurologic Examination Patient outcomes Pediatrics Premature infants Pulmonary Ventilation - drug effects Respiration, Artificial Respiratory diseases Respiratory Distress Syndrome, Newborn - drug therapy Respiratory Distress Syndrome, Newborn - mortality Steroids Teenagers Treatment Outcome Youth |
| title | Follow-up at 15 Years of Preterm Infants From a Controlled Trial of Moderately Early Dexamethasone for the Prevention of Chronic Lung Disease |
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