Published online February 1, 2008
PEDIATRICS Vol. 121 No. 2 February 2008, pp. 289-296 (doi:10.1542/peds.2007-1103)
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ARTICLE

Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants Exposed Prenatally to Dexamethasone Versus Betamethasone

Ben H. Lee, MD, MPH, MSCRa,b, Barbara J. Stoll, MDa, Scott A. McDonald, BSc, Rosemary D. Higgins, MDd for the National Institute of Child Health and Human Development Neonatal Research Network

a Division of Neonatal-Perinatal Medicine, Emory University School of Medicine, Atlanta, Georgia
b MidAtlantic Neonatology Associates, Morristown, New Jersey
c Research Triangle Institute, Research Triangle Park, North Carolina
d National Institute of Child Health and Human Development, Washington, DC

OBJECTIVE. We compared the development of adverse neurodevelopmental outcomes at corrected ages of 18 to 22 months for extremely low birth weight infants exposed prenatally to dexamethasone, betamethasone, or no steroid.

METHODS. Study infants were extremely low birth weight (401–1000 g) infants who were in the care of National Institute of Child Health and Human Development Neonatal Research Network centers between January 1, 2002, and April 30, 2003; they were assessed neurodevelopmentally at corrected ages of 18 to 22 months. Outcomes were defined as Bayley Scales of Infant Development-II Mental Development Index of <70, Bayley Scales of Infant Development-II Psychomotor Development Index of <70, bilateral blindness, bilateral hearing aid use, cerebral palsy, and neurodevelopmental impairment. Neurodevelopmental impairment was defined as ≥1 of the aforementioned outcomes.

RESULTS. A total of 1124 infants met entry criteria. There were no statistically significant associations between prenatal dexamethasone exposure and any follow-up outcome, compared with no prenatal steroid exposure. Prenatal betamethasone exposure was associated with reduced risks of hearing impairment and neurodevelopmental impairment and with increased likelihood of unimpaired status, compared with no prenatal steroid exposure. Compared with betamethasone, dexamethasone was associated with a trend for increased risk of Psychomotor Development Index of <70, increased risk of hearing impairment, and decreased likelihood of unimpaired status.

CONCLUSIONS. Prenatal betamethasone exposure was associated with increased likelihood of unimpaired neurodevelopmental status and reduced risk of hearing impairment at corrected ages of 18 to 22 months among extremely low birth weight infants, compared with prenatal dexamethasone exposure or no prenatal steroid exposure. Pending a randomized, clinical trial, it may be in the best interests of infants to receive betamethasone, rather than dexamethasone, when possible.

Key Words: prenatal glucocorticoid treatment • dexamethasone • betamethasone • extremely low birth weight • neurodevelopmental outcome

Abbreviations: BSID-II—Bayley Scales of Infant Development-II • CP—cerebral palsy • ELBW—extremely low birth weight • MDI—Mental Development Index • NICHD—National Institute of Child Health and Human Development • NDI—neurodevelopmental impairment • PDI—Psychomotor Development Index • PVL—periventricular leukomalacia • PDA—patent ductus arteriosus • CLD—chronic lung disease • ROP—retinopathy of prematurity • OR—odds ratio • CI—confidence interval • EGA—estimated gestational age • IVH—intraventricular hemorrhage

Accepted Jul 23, 2007.


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