| Finding the optimal postnatal dexamethasone regimen for preterm infants at risk of bronchopulmonary dysplasia: a systematic review of placebo-controlled trials. | |
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MedLine Citation:
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PMID: 19117904 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Wes Onland; Martin Offringa; Anne P De Jaegere; Anton H van Kaam |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Pediatrics Volume: 123 ISSN: 1098-4275 ISO Abbreviation: Pediatrics Publication Date: 2009 Jan |
Date Detail:
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Created Date: 2009-01-01 Completed Date: 2009-02-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376422 Medline TA: Pediatrics Country: United States |
Other Details:
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Languages: eng Pagination: 367-77 Citation Subset: AIM; IM |
Affiliation:
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Emma Children's Hospital, Academic Medical Center, Department of Neonatology, Amsterdam, Netherlands. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Bronchopulmonary Dysplasia
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diagnosis*,
drug therapy*,
etiology Dexamethasone / administration & dosage* Humans Infant, Newborn Infant, Premature* Infant, Premature, Diseases / diagnosis, drug therapy, etiology Randomized Controlled Trials as Topic / methods*, standards Risk Factors |
| Chemical | |
Reg. No./Substance:
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50-02-2/Dexamethasone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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