Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. 594-602 (doi:10.1542/peds.2007-0486)
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ARTICLE

Follow-up of a Randomized, Placebo-Controlled Trial of Dexamethasone to Decrease the Duration of Ventilator Dependency in Very Low Birth Weight Infants: Neurodevelopmental Outcomes at 4 to 11 Years of Age

T. Michael O'Shea, MD, MPHa, Lisa K. Washburn, MDa, Patricia A. Nixon, PhDa,b and Donald J. Goldstein, PhDa

a Department of Pediatrics, School of Medicine
b Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina

OBJECTIVE. High doses of dexamethasone reduce the risk of chronic lung disease among premature infants but may increase the risk of developmental impairments. The objective of this study was to compare developmental outcomes beyond infancy for children who, as neonates, participated in a randomized trial of dexamethasone.

PATIENTS AND METHODS. One hundred eighteen children with birth weights <1500 g were randomly assigned at 15 to 25 days of life to a 42-day tapering course of dexamethasone or placebo. All 95 survivors were assessed by using standardized measures of developmental outcome at least once at or beyond 1 year of age, and 84 were examined at 4 to 11 years. For this follow-up study, the outcome of primary interest was death or major neurodevelopmental impairment, which was defined as cerebral palsy, cognitive impairment, or blindness.

RESULTS. On the basis of each child's most recent follow-up, the rates of major neurodevelopmental impairments were 40% for the dexamethasone group and 20% for the placebo group. The higher impairment rate for the dexamethasone group was mainly attributed to a higher prevalence of cerebral palsy. Rates of the composite outcome of death or major neurodevelopmental impairment were 47% and 41%, respectively.

CONCLUSION. A 42-day tapering course of dexamethasone, which was shown previously to decrease the risk of chronic lung disease in very low birth weight infants, does not increase the risk of the composite outcome of death or major neurodevelopmental impairment.

Key Words: bronchopulmonary dysplasia • chronic lung disease • dexamethasone • glucocorticoids

Abbreviations: CLD—chronic lung disease • DAS—Differential Abilities Scales • VABS—Vineland Adaptive Behavioral Scales • WISC-III—Wechsler Intelligence Scale for Children, 3rd Edition • MDI—Mental Developmental Index • OR—odds ratio • CI—confidence interval

Accepted Jun 4, 2007.


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