Dexamethasone therapy increases infection in very low birth weight infants

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 p rospectively. Infections were classified as definite or possible/clinical. Results. A total of 371 infants were enrolled in the trial. There were no b aseline differences in risk factors for infection. For the first 14 days of study, infants received either dexamethasone (group I, 182) or placebo (gr oup II, 189). During this period, infants in group I were significantly mor e 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 h ad at least one episode of definite bacteremia/sepsis/meningitis (29% in gr oup I vs 21% in group II). Among infants with definite infections, 46.8% we re attributable to Gram-positive organisms, 26.6% to Gram-negative organism s and 26.6% to fungi. The factors present at randomization were evaluated f or their association with infection. Group I assignment and H-2 blocker the rapy (before study entry) were associated with increased risk of definite i nfection, whereas cesarean section delivery and increasing birth weight wer e associated with decreased risk. Conclusions. Infants who received a 14-day course of dexamethasone initiate d at 2 weeks of age were more likely to develop a bloodstream or cerebrospi nal fluid infection while on dexamethasone therapy than were those who rece ived placebo. Physicians must consider this increased risk of infection whe n deciding whether to treat VLBW infants with dexamethasone.