Impact of Postnatal Corticosteroid Use on Neurodevelopment at 18 to 22 Months' Adjusted Age: Effects of Dose, Timing, and Risk of Bronchopulmonary Dysplasia in Extremely Low Birth Weight Infants
| العنوان: | Impact of Postnatal Corticosteroid Use on Neurodevelopment at 18 to 22 Months' Adjusted Age: Effects of Dose, Timing, and Risk of Bronchopulmonary Dysplasia in Extremely Low Birth Weight Infants |
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| المؤلفون: | Deanne, Wilson-Costello, Michele C, Walsh, John C, Langer, Ronnie, Guillet, Abbot R, Laptook, Barbara J, Stoll, Seetha, Shankaran, Neil N, Finer, Krisa P, Van Meurs, William A, Engle, Abhik, Das, W K, Poole |
| المصدر: | Pediatrics. 123:e430-e437 |
| بيانات النشر: | American Academy of Pediatrics (AAP), 2009. |
| سنة النشر: | 2009 |
| مصطلحات موضوعية: | Pediatrics, medicine.medical_specialty, Developmental Disabilities, Anti-Inflammatory Agents, Gestational Age, Dexamethasone, Article, Cerebral palsy, Cohort Studies, medicine, Humans, Prospective Studies, Prospective cohort study, Bronchopulmonary Dysplasia, Dose-Response Relationship, Drug, business.industry, Cerebral Palsy, Infant, Newborn, Postmenstrual Age, Infant, Gestational age, medicine.disease, Survival Rate, Low birth weight, Bronchopulmonary dysplasia, Infant, Extremely Low Birth Weight, Sensation Disorders, Pediatrics, Perinatology and Child Health, medicine.symptom, business, Follow-Up Studies, medicine.drug, Cohort study |
| الوصف: | OBJECTIVE. Postnatal steroid use decreases lung inflammation but increases impairment. We hypothesized that increased dose is associated with increased neurodevelopmental impairment, lower postmenstrual age at exposure increases impairment, and risk of bronchopulmonary dysplasia modifies the effect of postnatal corticosteroid.METHODS. Steroid dose and timing of exposure beyond 7 days was assessed among 2358 extremely low birth weight infants nested in a prospective trial, with 1667 (84%) survivors examined at 18 to 22 months' postmenstrual age. Logistic regression tested the relationship between impairment (Bayley Mental Developmental Index/Psychomotor Developmental Index of 0.5 as high risk, n = 2336 (99%) for days of life 4–7).RESULTS. Three hundred sixty-six (16%) neonates were steroid-treated (94% dexamethasone). Treated neonates were smaller and less mature; 72% of those treated were at high risk for bronchopulmonary dysplasia. Exposure was associated with neurodevelopmental impairment/death. Impairment increased with higher dose; 71% dead or impaired at highest dose tertile. Each 1 mg/kg dose was associated with a 2.0-point reduction on the Mental Developmental Index and a 40% risk increase for disabling cerebral palsy. Older age did not mitigate the harm. Treatment after 33 weeks' postmenstrual age was associated with greatest harm despite not receiving the highest dose. The relationship between steroid exposure and impairment was modified by the bronchopulmonary dysplasia risk, with those at highest risk experiencing less harm.CONCLUSIONS. Higher steroid dose was associated with increased neurodevelopmental impairment. There is no “safe” window for steroid use in extremely low birth weight infants. Neonates with low bronchopulmonary dysplasia risk should not be exposed. A randomized trial of steroid use in infants at highest risk is warranted. |
| تدمد: | 1098-4275 0031-4005 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9d5c278468404885ffe62e56a40538d6Test https://doi.org/10.1542/peds.2008-1928Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....9d5c278468404885ffe62e56a40538d6 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 10984275 00314005 |
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