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Right arrow Premature & Newborn

PEDIATRICS Vol. 104 No. 5 November 1999, p. e63

ELECTRONIC ARTICLE:
Dexamethasone Therapy Increases Infection in Very Low Birth Weight Infants

Received Feb 1, 1999; accepted May 12, 1999.

Barbara J. Stoll*, Marinella TemprosaDagger , Jon E. Tyson§, Lu-Ann Papileparallel , Linda L. Wright, Charles R. Bauer#, Edward F. Donovan**, Sheldon B. KoronesDagger Dagger , James A. Lemons§§, Avroy A. Fanaroff||, David K. Stevenson¶¶, William Oh##, Richard A. Ehrenkranz***, Seetha ShankaranDagger Dagger Dagger , and Joel VerterDagger

From * Emory University, Atlanta, Georgia; Dagger  George Washington University Biostatistics Center, Rockville, Maryland; the § University of Texas Southwestern Medical Center, Dallas, Texas; parallel  University of New Mexico, Albuquerque, New Mexico;  National Institute of Child Health and Human Development, Bethesda, Maryland; # University of Miami, Miami, Florida; ** University of Cincinnati, Cincinnati, Ohio; Dagger Dagger  University of Tennessee at Memphis, Memphis, Tennessee; §§ Indiana University, Indianapolis, Indiana; || Case Western Reserve University, Cleveland, Ohio; ¶¶ Stanford University, Stanford, California; ## Women and Infants Hospital, Providence, Rhode Island; *** Yale University, New Haven, Connecticut; and Dagger Dagger Dagger  Wayne State University, Detroit, Michigan.

Background.  Infection is a major complication of preterm infants, resulting in increased morbidity and mortality. We recently reported the results of a multicenter trial of dexamethasone initiated at 14 or 28 days in very low birth weight (VLBW) infants who were at risk for chronic lung disease; the results showed an increase in nosocomial bacteremia in the group receiving dexamethasone. This study is an in-depth analysis of bacteremia/sepsis and meningitis among infants enrolled in the trial.

Methods.  Data on cultures performed and antibiotic therapy were collected prospectively. Infections were classified as definite or possible/clinical.

Results.  A total of 371 infants were enrolled in the trial. There were no baseline differences in risk factors for infection. For the first 14 days of study, infants received either dexamethasone (group I, 182) or placebo (group II, 189). During this period, infants in group I were significantly more likely than those in group II to have a positive blood culture result (48% vs 30%) and definite bacteremia/sepsis/meningitis (22% vs 14%). Over the 6-week study period, 47% of those cultured had at least one positive blood culture result (53% in group I vs 41% in group II) and 25% of the infants had at least one episode of definite bacteremia/sepsis/meningitis (29% in group I vs 21% in group II). Among infants with definite infections, 46.8% were attributable to Gram-positive organisms, 26.6% to Gram-negative organisms and 26.6% to fungi. The factors present at randomization were evaluated for their association with infection. Group I assignment and H2 blocker therapy (before study entry) were associated with increased risk of definite infection, whereas cesarean section delivery and increasing birth weight were associated with decreased risk.

Conclusions.  Infants who received a 14-day course of dexamethasone initiated at 2 weeks of age were more likely to develop a bloodstream or cerebrospinal fluid infection while on dexamethasone therapy than were those who received placebo. Physicians must consider this increased risk of infection when deciding whether to treat VLBW infants with dexamethasone.  Key words:  very low birth weight, dexamethasone, nosocomial infection.