Abstract
The objective of this study was to determine the impact of postnatal dexamethasone treatment on the neonatal unit on the school age lung function of very prematurely born children. Children born prior to 29 weeks of gestational age had been entered into a randomised trial of two methods of neonatal ventilation (United Kingdom Oscillation Study). They had comprehensive lung function measurements at 11 to 14 years of age. One hundred and seventy-nine children born at a mean gestational age of 26.9 (range 23–28) weeks were assessed at 11 to 14 years; 50 had received postnatal dexamethasone. Forced expiratory flow at 75% (FEF75), 50%, 25% and 25–75% of the expired vital capacity, forced expiratory volume in one second, peak expiratory flow and forced vital capacity and lung volumes including total lung capacity and residual volume were assessed. Lung function outcomes were compared between children who had and had not been exposed to dexamethasone after adjustment for neonatal factors using linear mixed effects regression. After adjustment for confounders all the mean spirometry results were between 0.38 and 0.87 standard deviations lower in those exposed to dexamethasone compared to the unexposed. For example, the mean FEF75 z-score was 0.53 lower (95% CI 0.21 to 0.85). The mean lung function was lower as the number of courses of dexamethasone increased. In conclusion, postnatal dexamethasone exposure was associated with lower mean lung function at school age in children born extremely prematurely. Our results suggest the larger the cumulative dose the greater the adverse effect on lung function at follow-up.
Highlights
Corticosteroids administered to prematurely born infants can facilitate early extubation and reduce the rate of bronchopulmonary dysplasia (BPD) [1, 2]
In a study of 16 children born between 24 to 29 weeks of gestation, who had been entered into a randomised controlled trial (RCT) at 10 days of age, no significant differences were found in respiratory morbidity between 7.8 and 9.2 years [4]
In a follow up of another RCT, no statistically significant differences were found in lung function results (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow (PEF), forced expiratory flow between 25% and 75% of VC (FEF25-75%)) at 13 to 17 years between the 68 prematurely born children who had received corticosteroids and the 74 who had received placebo at a median age of four weeks [5]
Summary
Corticosteroids administered to prematurely born infants can facilitate early extubation and reduce the rate of bronchopulmonary dysplasia (BPD) [1, 2]. In a follow up of another RCT, no statistically significant differences were found in lung function results (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow (PEF), forced expiratory flow between 25% and 75% of VC (FEF25-75%)) at 13 to 17 years between the 68 prematurely born children who had received corticosteroids and the 74 who had received placebo at a median age of four weeks [5]. In a cross-sectional study, 105 prematurely born children who had been exposed to postnatal corticosteroids, had lower FEV1 (p = 0.01), FEF25-75% (p = 0.003), and PEF (p = 0.02) at age 9–11 years [8]. It is important to note that none of those study populations [5,6,7,8] had been exposed to postnatal surfactant and few to antenatal corticosteroids
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