PULSE DEXAMETHASONE DOES NOT IMPAIR GROWTH AND BODY-COMPOSITION OF VERY-LOW-BIRTH-WEIGHT INFANTS

Objective: Evaluation of repeated pulses of dexamethasone (PDEX), give n to improve cardiopulmonary outcome, on growth of very low birth weig ht (VLBW, < 1500 g) infants. Methods: In this prospective, double-blin d, randomized clinical trial, VLBW infants mechanically ventilated at 1 week of age received intravenous PDEX or saline placebo (P) for 3 da ys, every 10 days, until no supplemental oxygen or ventilation was req uired or 36 weeks postmenstrual age (PMA). Weight gain, fluid intake, caloric intake, and serum glucose were monitored throughout the study. Nutritional assessment at 36 weeks PMA consisted of weight, length, h ead circumference, skinfold thickness measures, body composition by to tal body electrical conductance, and bone mineral content (BMC) by sin gle beam photon absorptiometry. Results: 37 PDEX and 31 P infants surv ived at least 36 days and completed the protocol. Average daily weight gain, fluid intake and caloric intake were not different between grou ps. The pattern of weight gain (g/kg/day, mean +/- SD) was different: PDEX infants showed significant growth delay during (3.0 +/- 11.4) and immediately after (7.8 +/- 8.7) each pulse, with subsequent growth ac celeration (18.3 +/- 8.2) until the next steroid pulse. In contrast, g rowth rate of P infants was constant (12.6 +/- 3.7) (p = 0.04). Hyperg lycemia requiring insulin therapy occurred only in the PDEX group (10/ 37). The catch-up growth noted between pulses in the PDEX group was ex plained only in part by insulin therapy. At 36 weeks PMA, there were n o differences between groups in body size, composition, or BMC. Conclu sion: PDEX negatively affected glucose metabolism and growth patterns during and immediately after drug exposure. However, assessment near t erm gestational age showed similar body composition and size in both g roups.