 |
|
 |
|
 |
 |
|
 |
 |
 |
 |
 |
 |
 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
PEDIATRICS Vol. 101 No. 5 May 1998, p. e7
,
From the Departments of Pediatrics, * National Cheng Kung
University Hospital, Tainan, ROC, China Medical College Hospital,
Taichung, ROC, and § Chang Gung Children's Hospital, Taipei, Taiwan,
ROC.
 |
ABSTRACT |
|---|
Top
Abstract
Introduction
Materials & Methods
Results
Discussion
References
|
|---|
Objectives. To study the outcome at 2-year corrected age of infants who participated in a double-blind controlled trial of early (<12 hours) dexamethasone therapy for the prevention of chronic lung disease (CLD).
Methods and Materials. A total of 133 children (70 in the control group, 63 in the dexamethasone-treated group) who survived the initial study period and lived to 2 years of age were studied. All infants had birth weights of 500 to 1999 g and had severe respiratory distress syndrome requiring mechanical ventilation within 6 hours after birth. For infants in the treatment group, dexamethasone was started at a mean age of 8.1 hours and given 0.25 mg/kg every 12 hours for 1 week and then tapered off gradually over a 3-week period. The following variables were evaluated: interim medical history, socioeconomic background, physical growth, neurologic examinations, mental and psychomotor development index score (MDI and PDI), pulmonary function, electroencephalogram, and auditory and visual evoked potential.
Results. Infants in the control group tended to have a
higher incidence of upper respiratory infection and rehospitalization than did the dexamethasone-treated group because of respiratory problems. Although there was no difference between the groups in
somatic growth in girls, the dexamethasone-treated boys had significantly lower body weight and shorter height than the control boys (10.7 ± 3.0 vs 11.9 ± 2.0 kg; 84.9 ± 5.7 vs 87.5 ± 4.8 cm). The dexamethasone-treated group had a significantly higher incidence of
neuromotor dysfunction (25/63 vs 12/70) than did the control group. The
dexa-methasone-treated infants also had a lower PDI score (79 ± 26) than did the control group (87 ± 23), but the difference
was not statistically significant. Both groups were comparable in MDI,
incidence of vision impairment, and auditory and visual evoked
potential. Significant handicap, defined as severe neurologic defect
and/or intellectual defect (MDI and/or PDI 
69), was seen in 22 children (31.4%) in the control group and 26 (41.2%) in the
dexamethasone-treated group.
Conclusions. Although early postnatal dexamethasone therapy for 4 weeks significantly reduces the incidence of CLD, this therapeutic regimen cannot be recommended at present because of its adverse effects on neuromotor function and somatic growth in male infants, detected at 2 years of age. A longer follow-up is needed. If early dexamethasone therapy is to be used for the prevention of CLD, the therapeutic regimen should be modified. The proper route of administration, the critical time to initiate the therapy, and the dosage and duration of therapy remain to be defined further.
Key words: preterm infant, early dexamethasone therapy, follow-up study.
Early postnatal dexamethasone therapy has been used
recently for the possible prevention of chronic lung disease (CLD) in preterm infants with respiratory distress syndrome
(RDS).1 However, very few long-term outcome studies
have been performed on these infants. In most of the previous follow-up
studies, dexamethasone had been given to infants We have recently conducted a multicenter double-blind trial of early
postnatal (<12 hours) dexamethasone therapy for the prevention of
CLD.7 In this study, we have shown that the early
dexamethasone therapy was associated with a significant decrease in the
incidence of CLD. However, the dexamethasone-treated infants also
experienced various transient but significant side effects, including
infection and sepsis, hyperglycemia, hypertension, cardiac hypertrophy, hyperparathyroidism, and a delay in weight gain. The present report summarizes the follow-up findings at about 2 years' postnatal age.
All infants born between October 1992 and April 1995 in the six
participating hospitals (National Cheng Kung University Hospital, Chang
Gung Children's Hospital, Mackay Memorial Hospital, China Medical
College Hospital, Chang Shan Medical College Hospital, and Kuang Tien
Hospital) whose birth weights ranged from 500 to 1999 g were
eligible for inclusion in the original double-blind multicenter
clinical trial. The criteria of selection for the study included 1)
severe radiographic RDS, requiring mechanical ventilation within 6 hours of birth, and 2) the absence of prenatal infection, complex
congenital anomalies, or lethal cardiopulmonary status. Each infant
received either dexamethasone or saline placebo intravenously; the
first dose was given within 12 hours after birth. In the infants who
received dexamethasone, the following schedule of dexamethasone sodium
phosphate was administered: 0.25 mg/kg/dose bid from day 1 to day 7, 0.12 mg/kg/dose bid from day 8 to day 14, 0.05 mg/kg/dose bid from day
15 to day 21, and 0.02 mg/kg/dose bid from day 22 to day 28. A standard
protocol for the management of infants with RDS was followed by the
participating hospitals.7 The diagnosis of CLD was
made if the infant had 1) respiratory distress requiring supplemental
oxygen therapy for A total of 262 infants were included in the initial study; 130 received
saline placebo and 132 received dexamethasone. The result of the study
was reported previously.7 In summary, early dexamethasone
therapy significantly reduced the incidence of CLD determined either at
the 28th postnatal day (21/132 in the dexamethasone-treated group vs
40/130 in the control group) or at the 36th postconceptional week
(20/132 in the dexamethasone-treated group vs 37/130 in the control
group). The mortality rate was comparable between the two groups
(44/132 in the treated group vs 39/130 in the control group).
Significantly more infants in the dexamethasone-treated group had
bacteremia and/or clinical sepsis (43/132 vs 27/130). Dexamethasone-treated infants had transient hyperglycemia,
hypertension, cardiac hypertrophy, hyperparathyroidism, and a transient
delay in the rate of weight gain. By postnatal day 28, there was no significant difference between the groups in any of these variables.
Follow-up Study
The follow-up study was performed at about 2 years' postnatal
age. Of the 262 infants included in the initial study, 39 in the
control group and 44 in the dexamethasone-treated group died during the
initial study period. Of the 179 initial survivors, 9 infants in the
control group and 13 in the dexamethasone-treated group could not be
located. The total number of infants located was 157 (87.7%). However,
the follow-up study could not be completed in 3 infants in the control
group and 6 infants in the dexamethasone-treated group because of
either absence of parental consent or lack of cooperation from the
children. In addition, 9 infants in the control group (all had CLD) and
6 in the dexa-methasone-treated group (5 had CLD) died during the
first 2 years of age. Most of these infants died of respiratory
problems. Because none of these infants underwent autopsy, the cause of
death could not be well defined. The total number of children included
for data analyses was 133 (81% of the survivors who lived to 2 years
of age and who could be located); of these, 70 were in the control
group and 63 in the dexamethasone-treated group.
The follow-up study was performed at the central participating hospital
(National Cheng Kung University Hospital). At each visit, an interim
medical history was obtained and a physical examination was performed.
Weight, occipitofrontal head circumference, and supine crown-heel
length measurements were recorded. Each medical examination was
accompanied by a neurologic assessment of mental status, motor
development (including coordination, general reflex, muscle tone), and
cranial nerves by a pediatric neurologist (C.C.H.). The neuromotor
dysfunction was classified as mild, moderate, or severe, based on the
mobility of the child, as described by Costello et
al.12 Motor dysfunction not severe enough to interfere with the mobility was defined as mild. Dysfunction was defined as
moderate if the child was independently mobile when provided hand-holding, and severe if the child was not independently mobile even
with hand-holding. A standard 12-lead monopolar and bipolar electroencephalogram (EEG) also was performed and included visual stimulation (visual evoked potential [VEP]) and auditory stimulation (brain stem auditory evoke potential [BAEP]) at 30 and 70 dB by a
pediatric neurologist (Y.J.C.). Psychometric evaluations were performed
using the Bayley Scale of Infant Development (BSID) by a pediatric
psychologist (Y.J.L.). Data were obtained on mental and motor
development. The cardiopulmonary status of the infant also was
evaluated at each visit. A clinical RDS score of Downes et
al,13 which evaluated the respiratory rate, degree of
retraction, color, and degree of grunting and breath sounds, was used.
Arterialized capillary samples were obtained for blood gas and
acid-base analysis. Pulmonary function test (BICORE Monitoring System,
Inc, Irvine, CA) was performed to measure tidal volume, respiratory
rate, and total dynamic lung compliance and resistance.
All tests were performed in the presence of the infant's mother or
guardian, with the examiners completely blinded to group assignment.
For analysis of physical growth and developmental performance, the
infant's postnatal age was corrected by the degree of prematurity
before term (40 weeks).
All infants were from one ethnic group of Chinese descendants. Data on
family background and socioeconomic status were obtained from parents
or, occasionally, from a guardian. Maternal education level was
classified into four categories: below high school graduation (compulsory 9-year education), high school graduate (12 years), some
college education (12 to 16 years), and college graduate (>16 years).
The average annual income per capita in Taiwan is about US $14 000.
Family income was probably underreported because this information was
obtained only through verbal communication. The father's occupation
was evaluated using a scoring system modified from Hollingshead and
Redlich.14,15
Statistics
Analysis of variance and, where appropriate, the t
test were used to make group comparisons for continuous variables. The Perinatal Period
The clinical and biochemical characteristics in the perinatal
period of the follow-up study infants are shown in Table
1. All variables showed no significant
differences between the control and dexamethasone-treated groups. There
also was no significant difference between the groups with respect to
inborn or outborn status (14/70 vs 13/63) and proportion of prenatal
glucocorticoid therapy (21/70 vs 21/63). None of the mothers were drug
abusers. The initial cardiopulmonary status on admission to the
neonatal intensive care unit also was comparable between the groups.
The mean postnatal age at the time of the first dose of dexamethasone was 8.1 ± 2.8 hours.
TABLE 1
INTRODUCTION
Top
Abstract
Introduction
Materials & Methods
Results
Discussion
References
2 weeks of
age.8 Moreover, the study cases were not randomized,
used historic control, or had small sample sizes.8,9,11
None of these studies has shown a clear difference in the growth and
development between the dexamethasone-treated and control infants.
SUBJECTS AND METHODS
Top
Abstract
Introduction
Materials & Methods
Results
Discussion
References
28 days and 2) an abnormal chest radiograph. All
infants were also observed for possible side effects during the study.
2 test was used to compare groups with respect to
categoric variables. The simple two-variable regression analysis was
used to compare the values of a selective continuous variable with the
corresponding values of other selective continuous variables.
Multiple correlations were performed to evaluate the outcome at 2 years' postnatal age in relation to perinatal and neonatal factors.
Except where indicated otherwise, values are specified as mean ± SD.
RESULTS
Top
Abstract
Introduction
Materials & Methods
Results
Discussion
References
The Clinical and Biochemical Characteristics in the Perinatal Period
Initial Hospital Course
Clinical features during the initial hospital course that may
affect the long-term prognoses are shown in Table
2. More infants in the control group than
in the dexamethasone-treated group had CLD (26/70 vs 13/63) but the
difference was not statistically significant. Infants in the
dexamethasone-treated group had a significantly lower incidence of
clinical patent ductus arteriosus and required a shorter duration of
high O2 therapy
(FIO2 > 0.4) than did the control infants.
There was no significant difference between the groups in the incidence
of intraventricular hemorrhage (Gr II), retinopathy of prematurity,
and duration of mechanical ventilation, total supplemental
O2 therapy, and hospitalization. Eight infants
in the control group and 5 in the dexamethasone-treated group who had
severe CLD required the open steroid therapy after completion of the
initial study. The open steroid therapy (0.25 mg/kg/q 12 hours) was
given only to infants who were respirator-dependent. The duration of
therapy usually lasted for 4 to 7 days. The purpose of steroid therapy
in these infants was primarily for facilitating weaning from
intermittent mechanical ventilation. Steroid therapy was usually
discontinued after a maximum of 7 days. Because of the small number of
infants receiving the open steroid therapy and the relatively short
duration of therapy, these infants were not excluded from the follow-up
study. Of the 8 infants in the control group who received open steroid
therapy, 5 had neuromotor dysfunction (1 severe, 2 moderate, and 2 mild). Of the 5 infants in the dexamethasone-treated group who received
open steroid, 3 had neuromotor dysfunction (2 severe, 1 moderate).
|
Social History
The socioeconomic status of the family is shown in Table 3. Both groups were comparable with respect to the maternal age, maternal education levels, father's occupation, and family income. Most of the children came from middle class families. Sixty eight parents in the control group and 62 in the dexa-methasone-treated group were married and living together. Two parents in the control group and one in the dexamethasone-treated group were widowed, separated, or divorced from their spouse and living alone. Sixty-seven children in the control group and 61 in the dexamethasone-treated group were living with their natural parent. Three children in the control and 2 in the dexamethasone-treated group were living with grandparents or guardians.
|
General Health
The mean postnatal age at the time of follow-up was 27.4 ± 5.4 months for the control group and 26.7 ± 4.6 months for the dexamethasone-treated group. The corrected age was 25.4 ± 5.4 months for the control group and 24.3 ± 4.4 months for the dexamethasone-treated group. Three infants in the control group, who had CLD, still had mild respiratory distress at the time of follow up; two of the three required supplemental oxygen therapy. One infant in the dexamethasone-treated group had clinical respiratory distress but did not require supplemental O2 therapy. Nineteen infants (17 with CLD) in the control group and 12 (9 with CLD) infants in the dexamethasone-treated group required rehospitalization; this difference was not statistically significant. There was no difference between the groups in the incidence of frequent upper respiratory infection (32/70 vs 23/63), defined as >10 upper respiratory infections per year. Blood pressure (BP) was comparable between the control and dexamethasone-treated infants at the time of follow-up (systolic BP, 98 ± 15 vs 96 ± 20 mm Hg; diastolic BP, 44 ± 12 vs 46 ± 18).
Twenty-one infants in the control group and 17 in the dexamethasone-treated group had eye problems. Strabismus was seen in 12 control and 8 dexamethasone-treated infants, nystagmus in 6 control and 4 dexamethasone-treated infants, and significant vision impairment in 3 control and 5 dexamethasone-treated infants.
Physical Growth
The body weight, height, and head circumference of the individual male and female child are plotted, based on their corrected age, on the growth chart for Chinese children (Figs 1 and 2). In the girls, there was no significant difference between the control and dexamethasone-treated groups with respect to mean body weight (10.8 ± 2.1 vs 10.6 ± 1.8 kg), height (84.2 ± 5.8 vs 83.8 ± 6.0 cm), and head circumference (46.2 ± 1.9 vs 46.1 ± 2.1 cm). There also was no significant difference between the groups with respect to distribution of weight, height, and head circumference on the growth chart. Five infants in the dexamethasone-treated group and eight infants in the control group had body weight below the third percentile. None in the dexamethasone-treated group and one in the control group had height below the third percentile.
|
|
In the boys, there was no significant difference between the control and dexamethasone-treated groups in head circumference (47.2 ± 1.8 vs 47.1 ± 2.0 cm). However, the body weight was significantly lower (P < .05) and height significantly shorter (P < .05) in the dexamethasone-treated group than in the control group (10.7 ± 3.0 vs 11.9 ± 2.0 kg and 84.9 ± 5.7 vs 87.5 ± 4.8 cm, respectively). Five infants in the dexamethasone-treated group and one in the control group had body weight below the third percentile. Three infants in the dexamethasone-treated group and none in the control group had height below the third percentile.
Neurologic Assessment
Six children in the control group and seven in the dexamethasone-treated group had a history of clinical seizure. Table 4 summarizes the neurologic diagnosis. A greater proportion of infants in the dexa-methasone-treated group (25/63) than in the control (12/70) group had abnormal neurologic examination (P < .01). More infants in the dexamethasone-treated group than in the control group were likely to have diplegia and hypotonia. Classifying the severity of neuromotor dysfunction as defined in "Subjects and Methods," more infants in the dexamethasone-treated group (13/63) than in the control group (4/70) had moderate neuromotor dysfunction (P < .05). The incidence of severe neurologic dysfunction was comparable between the groups (2/70 vs 5/63).
|
EEG, BAEP, and VEP
Fifteen infants in the control group (21.4%) and 15 infants in the dexamethasone-treated group (23.8%) had abnormal EEG findings. More infants in the dexamethasone-treated group than in the control group were likely to have excessive fast activity (8/63 vs 2/70; P > .05). Excessive fast activity was defined if there was a considerable amount of fast activity with frequencies of predominantly 20 to 26 per second occurred during wakefulness and were found over the area past the frontal region. Excessive fast activity was reported to be seen often in infants with neuromotor dysfunction.16 Paroxysmal discharge with focal spike/sharp wave activity was seen in 9 infants in the control group and in 6 infants in the dexamethasone-treated group, and multiple spike activity was seen in 2 infants in the control group and in 2 infants in the dexamethasone-treated group. Nonparoxysmal discharge with local slow activity was seen in 2 infants in the control group and 2 infants in the dexamethasone-treated group. Combined paroxysmal and nonparoxysmal abnormality was seen in 1 infant in the control group and in 1 infant in the dexamethasone-treated group. No significant correlation could be shown between the abnormal EEG patterns and neurologic outcome. There was no significant difference between the groups either in proportion of abnormal BAEP (with 30 dB, 4/70 vs 4/63; with 70dB, 3/70 vs 4/63) or in the mean values of amplitude and interval of BAEP and VEP.
Intellectual Development (Table 5)
The mean mental development index score (MDI) was 78 ± 20 for the
control group and 74 ± 21 for the dexamethasone-treated group. This
difference in MDI between the groups was not statistically significant.
The mean psychomotor developmental index score (PDI) for the
dexamethasone-treated group was 79 ± 26 and for the control group was
87 ± 23. This difference also was not statistically significant.
Sixteen infants in the control group (23%) and 25 in the
dexamethasone-treated group (39%) had PDI scores of 69. This
difference in proportion of infants with PDI 69 between the groups
was not statistically significant. The proportion of infants with PDI
<85 also was comparable between the groups (28/70 vs 36/63). Both PDI
and MDI were <69 for the 2 children in the control group and the 5 in
the dexamethasone-treated group who had severe neurologic defects.
|
Significant Handicap With Severe Neurologic and/or Intellectual Defects
The total number of children with significant handicap, either
from severe neurologic defects as defined in "Subjects and Methods"
or from significant intellectual defects (PDI and/or MD 69), was seen
in 22 (31.4%) children in the control group and 26 (41.2%) in the
dexamethasone-treated group. This difference in proportion of infants
with significant handicap between the groups was not statistically
significant.
Correlation of Significant Handicap With Perinatal Events and Neonatal Course
Comparison of infants with significant handicap and those without
handicap within the control group showed no significant difference in
perinatal characteristics and neonatal course. Similarly, comparison of
infants with significant handicap and those without handicap within the
dexamethasone-treated group showed no significant difference in
perinatal characteristics and neonatal course. However, when comparison
of infants with handicap and those without handicap of all infants
studied was performed, more infants in the handicapped group were
likely to have been born by vaginal delivery (30/48 [63%] vs 35/85
[41%]) and to have required intubation immediately after birth
(26/48 [54%] vs 31/85 [36%]), suggesting that they were probably
more sick at birth. There was no significant difference between the
handicapped and nonhandicapped children in incidence of prenatal
steroid therapy or in Apgar score at both 1 minute and 5 minutes. The
incidence of IVH (Gr II) during the neonatal course was comparable
between the handicapped and nonhandicapped children (14/48 vs 29/85).
Multiple correlations failed to find any significant correlation
between the presence of handicap at 2 years of age and the perinatal
events.
| |
DISCUSSION |
|---|
|
Top
Abstract
Introduction
Materials & Methods
Results
Discussion
References
|
|---|
The present report summarizes the follow-up findings, at ~2 years of age, of a select group of infants who participated in a double-blind trial of early postnatal (<12 hours) dexamethasone therapy for prevention of CLD. Infants who received early dexamethasone therapy for 4 weeks were likely to be associated with neuromotor dysfunction and a delay in somatic growth, particularly in boys.
Glucocorticoids have been used for years in infants with bronchopulmonary dysplasia.17 The use of steroid was often associated with short-term benefits of improving lung compliance and facilitating the early removal of the endotracheal tube.17 Glucocorticoids recently have been given early in postnatal life for possible prevention of CLD.1 The results of these studies were mixed, and some were conflicting. It is difficult to interpret these results because each of these studies was designed differently with respect to the time of initiating therapy, dosage and duration of therapy, and the sample size. In our multicenter double-blind trial,7 we have demonstrated a significant decrease in incidence of CLD associated with early dexamethasone therapy. However, the mortality rate was not decreased, possibly because more infants died of infection and sepsis. Side effects associated with dexamethasone therapy were transient, including hyperglycemia, hypertension, cardiac hypertrophy, hyperparathyroidism, and a delay in weight gain.7
The long-term side effects of early dexamethasone therapy have not been
well studied, although this concern has been emphasized by various
investigators.20,21 Mammal et al9 followed
eight ventilator-dependent infants with bronchopulmonary dysplasia who were treated with dexamethasone (0.5 mg/kg/day) for 7 days and then
tapered over 2 weeks. The authors could not find any significant long-term sequelae at 1 year of age in these infants compared with
eight similar ventilator-dependent infants. In this study, the first
dose of dexamethasone was given at 2 weeks' postnatal age. Cummings
et al8 conducted a double-blind trial on 36 preterm infants
who were dependent on oxygen and mechanical ventilation at 2 weeks of
age. The authors concluded that dexamethasone therapy for 42 days
improved pulmonary and neurodevelopmental outcome when followed at 6 and 15 months of age. O'Shea et al11 conducted a
longitudinal follow-up on 61 preterm infants treated with a 42-day
course of dexamethasone starting at 2 weeks of age, and 61 historic
controls matched for birth weight, gestational age, race, and sex.
Dexamethasone treatment was associated with fewer days of assisted
ventilation but not with improved outcome at age 1 year. Jones et
al10 conducted a 3-year follow-up of a group of children
who participated in a multicenter controlled trial of dexamethasone in
neonatal CLD. Dexamethasone was given to infants 2 to 12 weeks of age.
No conclusion could be drawn from this study because many infants in
the placebo group eventually also received open steroid therapy. Our
study was conducted in a double-blind design and on a uniform
population with respect to race and family socioeconomic background.
The proportion of infants in each group that subsequently received open
steroid therapy was also small and comparable. We believe that our
cases provided a good population sample for the study and that our
results revealed some adverse effects of early dexamethasone therapy at 2 years of age.
Consistent with the higher incidence of neuromotor dysfunction, the dexamethasone-treated infants also show a somewhat lower PDI score; both neuromotor and PDI were assessed independently by a pediatric neurologist and a pediatric psychologist. The mechanism for the neurologic abnormalities is not known. Neonatal animal experiments with pharmacologic doses of dexamethasone have revealed adverse effects on brain cell division, differentiation, myelination, and electrophysiologic reactions.22 Whether these effects can be applied to human neonates remain to be investigated.
Concerns regarding the effects of early dexamethasone therapy on somatic growth have been based on effects that steroids may alter cell size and DNA synthesis in animal models.23,24 In the present study, infants in the dexamethasone-treated group seemed to achieve less growth in height and weight than infants in the control group, particularly in boys at 2 years of age. Projections of adult stature and potential dexamethasone-mediated alterations of normal pubertal growth acceleration are not known. A long-term follow-up is needed to assess further whether these infants will catch up in growth at school age. Although we did not measure the lung volume, both groups of infants had comparable clinical respiratory status and lung compliance, suggesting that dexamethasone therapy probably did not have much long-term effect on lung growth.21
The Bayley II results are difficult to interpret and one wonders about the justification of using this test in Chinese children because we do not have a Chinese version and standardization for our population. The PDI and MDI scores obtained in this study were lower than those reported previously in the literature. In most of the previous studies, however, in which the psychometric evaluations were performed using BSID-I, their scores were usually higher than with BSID. The race/ethnic or culture bias also may explain the low score in our population. Because of the low psychometric score, the incidence of significant handicap, defined either by severe neurologic dysfunction and/or low psychometric score, was relatively higher in both groups when compared with other reports.8,9
As with findings from other investigators,25,26 we found that the mode of delivery may be an important risk factor related to poor outcome. Infants who were born by vaginal delivery were likely to have high incidence of neurodevelopmental anomalies. Previous studies suggested that preterm infants born by vaginal delivery were likely to have early IVH26,27 and poor neurodevelopmental outcome. However, we did not observe a difference in incidence of IVH (Gr) between the handicapped and nonhandicapped children.
We conclude that although early postnatal dexamethasone therapy significantly reduced the incidence of CLD in preterm infants with RDS, this therapeutic regimen cannot be recommended at present because of its adverse effects on neuromotor function and somatic growth detected at 2 years of age. A longer follow-up is needed. The results of our study also raise a serious caution about glucocorticoid therapy that was commonly used in infants with established CLD. We strongly suggest that if dexamethasone is to be used for early prevention of CLD, a modification of the therapeutic regimen is needed. The proper route of administration, the time of starting the therapy, and the dosage and duration of therapy remain to be studied further.
| |
FOOTNOTES |
|---|
Received for publication Sep 29, 1997; accepted Jan 5, 1998.
This paper was presented in part at the Annual Meeting of the American Pediatric Society and Society for Pediatric Research; Washington, DC; May 3, 1997.
Reprint requests to (T.F.Y.) Department of Pediatrics, National Cheng Kung University Hospital, 138, Sheng Li Rd, Tainan, Taiwan, ROC.
| |
ACKNOWLEDGMENTS |
|---|
This study was supported by National Health Research Institute and Department of Health Grants DOH84-HR-217 and DOH85-HR-529, and by Ho's Foundation for Prematurity, Taiwan, ROC.
We also thank Dr W.F. Tsai for technical help, Dr S.T. Wang for statistical assistance, Dr R.S. Pildes, Dr N.S. Wang for reviewing the manuscript, and Miss S.Y. Chen for manuscript preparation.
| |
ABBREVIATIONS |
|---|
CLD, chronic lung disease. RDS, respiratory distress syndrome. EEG, electroencephalogram. VEP, visual evoked potential. BAEP, brainstem auditory evoked potential. BSID, Bayley Scale of Infant Development. BP, blood pressure. PDI, psychomotor development index. MDI, mental development index.
| |
REFERENCES |
|---|
|
Top
Abstract
Introduction
Materials & Methods
Results
Discussion
References
|
|---|
This article has been cited by other articles:
 |
|
 |
|
  C. R. Neal Jr., G. Weidemann, M. Kabbaj, and D. M. Vazquez Effect of neonatal dexamethasone exposure on growth and neurological development in the adult rat Am J Physiol Regulatory Integrative Comp Physiol, August 1, 2004; 287(2): R375 - R385. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
||
|
||
Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 1998 American Academy of Pediatrics. All rights reserved. |
||
|
||
