Document Detail


Dexamethasone therapy increases infection in very low birth weight infants.
MedLine Citation:
PMID:  10545589     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Infection is a major complication of preterm infants, resulting in increased morbidity and mortality. We recently reported the results of a multicenter trial of dexamethasone initiated at 14 or 28 days in very low birth weight (VLBW) infants who were at risk for chronic lung disease; the results showed an increase in nosocomial bacteremia in the group receiving dexamethasone. This study is an in-depth analysis of bacteremia/sepsis and meningitis among infants enrolled in the trial. METHODS: Data on cultures performed and antibiotic therapy were collected prospectively. Infections were classified as definite or possible/clinical. RESULTS: A total of 371 infants were enrolled in the trial. There were no baseline differences in risk factors for infection. For the first 14 days of study, infants received either dexamethasone (group I, 182) or placebo (group II, 189). During this period, infants in group I were significantly more likely than those in group II to have a positive blood culture result (48% vs 30%) and definite bacteremia/sepsis/meningitis (22% vs 14%). Over the 6-week study period, 47% of those cultured had at least one positive blood culture result (53% in group I vs 41% in group II) and 25% of the infants had at least one episode of definite bacteremia/sepsis/meningitis (29% in group I vs 21% in group II). Among infants with definite infections, 46.8% were attributable to Gram-positive organisms, 26.6% to Gram-negative organisms and 26.6% to fungi. The factors present at randomization were evaluated for their association with infection. Group I assignment and H(2) blocker therapy (before study entry) were associated with increased risk of definite infection, whereas cesarean section delivery and increasing birth weight were associated with decreased risk. CONCLUSIONS: Infants who received a 14-day course of dexamethasone initiated at 2 weeks of age were more likely to develop a bloodstream or cerebrospinal fluid infection while on dexamethasone therapy than were those who received placebo. Physicians must consider this increased risk of infection when deciding whether to treat VLBW infants with dexamethasone.
Authors:
B J Stoll; M Temprosa; J E Tyson; L A Papile; L L Wright; C R Bauer; E F Donovan; S B Korones; J A Lemons; A A Fanaroff; D K Stevenson; W Oh; R A Ehrenkranz; S Shankaran; J Verter
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Pediatrics     Volume:  104     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  1999 Nov 
Date Detail:
Created Date:  1999-11-23     Completed Date:  1999-11-23     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  e63     Citation Subset:  IM    
Affiliation:
Emory University, Atlanta, Georgia 30335, USA. barbara_stoll@oz.ped.emory.edu
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MeSH Terms
Descriptor/Qualifier:
Cross Infection / chemically induced*,  microbiology
Dexamethasone / adverse effects*
Female
Glucocorticoids / adverse effects*
Humans
Infant, Newborn
Infant, Very Low Birth Weight*
Male
Meningitis / chemically induced
Prospective Studies
Risk Factors
Sepsis / chemically induced*,  microbiology
Grant Support
ID/Acronym/Agency:
U01 HD19897/HD/NICHD NIH HHS; U01 HD21373/HD/NICHD NIH HHS; U10 HD27851/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Glucocorticoids; 50-02-2/Dexamethasone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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