As a result of studies in the 1970s demonstrating that corticosteroids were effective in treating or preventing respiratory distress in premature infants, the practice became standard. There appeared over time, however, evidence of adverse neurologic effects related to such treatment, and even though the American Academy of Pediatrics recommended against it in 2002, the practice persists.
Perhaps a recent study will finally make clinicians heed the warnings. The study shows that premature infants who're given dexamethasone to prevent bronchopulmonary dysplasia, also known as chronic lung disease of prematurity, suffered from poor growth and impaired neuromuscular and cognitive functioning by the time they reached school age.
Chinese researchers followed 262 children born between October 1992 and April 1995 who had participated in a study of dexamethasone therapy to prevent bronchopulmonary dysplasia. All had had severe respiratory distress requiring mechanical ventilation within six hours of birth. They were randomized to receive either dexamethasone or a saline placebo. Of the 262, 159 survived to school age; the mortality rates in the two groups were similar. One hundred forty-six participated in the follow-up study (72 from the dexamethasone group and 74 from the control group).
Although the rate of chronic lung disease was lower in the dexamethasone group than in the control group (21% versus 35%, respectively), this benefit was outweighed by the neurodevelopmental problems, many of which caused significant disability, experienced by those receiving dexamethasone.
In 40% of those in the dexamethasone group, motor functioning was below the fifth percentile (low enough to necessitate intervention), compared with 20% of those in the control group. Children in the dexamethasone group also had significantly lower IQ scores and had lower scores on tests of verbal and written language skills, arithmetic, perceptual organization, freedom from distractibility, and processing speed. They were also more likely to experience delays in growth.
Although lower dosages of corticosteroids may still be effective in infants who have progressive lung injury two or more weeks after birth, further study on long-term effects is still needed. Clinicians should be aware that the adverse neurodevelopmental consequences of any postnatal treatment with corticosteroids may outweigh the possible improvements in pulmonary functioning.-Fran Mennick, BSN, RN
Yeh TF, et al. N Engl J Med 2004;350(13): 1304-13; Jobe AH. N Engl J Med 2004; 350(13):1349-51.