Published online June 1, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. 2196-2205 (doi:10.1542/peds.2005-2194)
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Right arrow Premature & Newborn

Neurodevelopmental and Respiratory Follow-up Results at 7 Years for Children From the United Kingdom and Ireland Enrolled in a Randomized Trial of Early and Late Postnatal Corticosteroid Treatment, Systemic and Inhaled (the Open Study of Early Corticosteroid Treatment)

Trevor T. Wilson, BSca,b, Lorraine Waters, BScc, Chris C. Patterson, PhDd, Chris G. McCusker, PhDe, Nichola M. Rooney, PhDe, Neil Marlow, MDc and Henry L. Halliday, MDa,b

a Regional Neonatal Unit, Royal Maternity Hospital, Belfast, Northern Ireland
b Child Health
d Epidemiology and Public Health, Queen’s University of Belfast, Belfast, Northern Ireland
c Queen’s Medical Centre, Nottingham, United Kingdom
e Clinical Psychology Department, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland

OBJECTIVES. The goals were to compare early school-age neurodevelopmental and respiratory outcomes for children who were treated with either early (<3 days) or delayed selective (>15 days) postnatal corticosteroid therapy and to compare systemic dexamethasone treatment with inhaled budesonide treatment.

METHODS. One hundred twenty-seven (84%) of 152 survivors from the United Kingdom and Ireland who were recruited to the Open Study of Early Corticosteroid Treatment, a randomized trial of inhaled and systemic corticosteroid therapy to prevent chronic lung disease, were traced and assessed at a median age of 7 years. Outcome measures were level of disability, presence of cerebral palsy, cognitive ability, behavioral difficulties and competencies, growth, and respiratory symptoms. Results were adjusted for potential confounding variables (gestational age, birth weight, gender, prenatal steroid therapy, method of delivery, Apgar score at 5 minutes, and Clinical Risk Index for Babies score).

RESULTS. There were no significant differences among the treatment groups in cognitive ability, behavioral competencies or difficulties, overall disability rates, cerebral palsy, combined outcomes of death or cerebral palsy and death or moderate/severe disability, growth, respiratory morbidity, or diastolic blood pressure. Those assigned to dexamethasone were more likely to have high systolic blood pressure and to have a diagnosis of asthma than were those assigned to budesonide.

CONCLUSIONS. Although postnatal steroid therapy has been associated with poor long-term outcomes, this study failed to show significant differences in cognitive function between dexamethasone- and budesonide-allocated groups. There may be increased systolic blood pressure and a greater likelihood of developing asthma in childhood after postnatal dexamethasone treatment.

Key Words: preterm • follow-up • glucocorticoids • corticosteroids • systemic dexamethasone • inhaled budesonide • chronic lung disease • bronchopulmonary dysplasia • general cognitive ability • cerebral palsy

Abbreviations: CLD—chronic lung disease • GCA—general conceptual ability • SDQ—Strengths and Difficulties Questionnaire • OSECT—Open Study of Early Corticosteroid Treatment • CI—confidence interval

Accepted Dec 28, 2005.