Document Detail

Finding the optimal postnatal dexamethasone regimen for preterm infants at risk of bronchopulmonary dysplasia: a systematic review of placebo-controlled trials.
MedLine Citation:
PMID:  19117904     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Postnatal dexamethasone therapy reduces the incidence of bronchopulmonary dysplasia in preterm infants but may be associated with an increased risk for adverse neurodevelopmental outcome. OBJECTIVE: Our goal was to determine if the effects of dexamethasone on mortality and pulmonary and neurodevelopmental sequelae in preterm infants are modified by the cumulative dose given. METHODS: Randomized, controlled trials comparing dexamethasone with placebo in ventilated preterm infants >7 days old were identified by searching the electronic databases and the abstracts from the Pediatric Academic societies and by performing manual reference searches. Two reviewers independently assessed eligibility and quality of trials and extracted data on study design, patient characteristics, and relevant outcomes. Original trialists were asked to provide additional data. RESULTS: Sixteen trials including 1136 patients were analyzed by using meta-analysis and metaregression. Additional data were provided by 12 original trialists. Trials with a moderately early (7- to 14-day) or delayed (>3-week) postnatal treatment onset were analyzed separately. Higher dexamethasone doses reduced the relative risk for the combined outcome, mortality or bronchopulmonary dysplasia, with the largest effect in trials that used a cumulative dose of >4 mg/kg. No effect was found of doses on the risk of neurodevelopmental sequelae in the delayed treatment studies, but in the moderately-early-treatment studies the risk of mortality or cerebral palsy decreased by 6.2%, and the risk of a Mental Developmental Index below -2 SDs decreased by 6.6% for each incremental mg/kg cumulative dexamethasone dose. CONCLUSIONS: Higher cumulative dexamethasone doses administered after the first week of life may decrease the risk for bronchopulmonary dysplasia without increasing the risk for neurodevelopmental sequelae in ventilated preterm infants. A large randomized trial is needed to confirm or refute these findings.
Wes Onland; Martin Offringa; Anne P De Jaegere; Anton H van Kaam
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Pediatrics     Volume:  123     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-01     Completed Date:  2009-02-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  367-77     Citation Subset:  AIM; IM    
Emma Children's Hospital, Academic Medical Center, Department of Neonatology, Amsterdam, Netherlands.
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MeSH Terms
Bronchopulmonary Dysplasia / diagnosis*,  drug therapy*,  etiology
Dexamethasone / administration & dosage*
Infant, Newborn
Infant, Premature*
Infant, Premature, Diseases / diagnosis,  drug therapy,  etiology
Randomized Controlled Trials as Topic / methods*,  standards
Risk Factors
Reg. No./Substance:

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