Early postnatal dexamethasone treatment and increased incidence of cerebral palsy

Objective-To study the long term neurodevelopmental outcome of children who participated in a randomised, double blind, placebo controlled study of ea rly postnatal dexamethasone treatment for prevention of chronic lung diseas e. Methods-The original study compared a three day course of dexamethasone (n = 132) with a saline placebo (n = 116) administered from before 12 hours of age in preterm infants, who were ventilated for respiratory distress syndr ome and had received surfactant treatment. Dexamethasone treatment was asso ciated with an increased incidence of hypertension, hyperglycaemia, and gas trointestinal haemorrhage and no reduction in either the incidence or sever ity of chronic lung disease or mortality. A total of 195 infants survived t o discharge and five died later. Follow up data were obtained on 159 of 190 survivors at a mean (SD) age of 53 (18) months. Results-No differences were found between the groups in terms of perinatal or neonatal course, antenatal steroid administration, severity of initial d isease, or major neonatal morbidity. Dexamethasone treated children had a s ignificantly higher incidence of cerebral palsy than those receiving placeb o (39/80 (49%) v 12/79 (15%) respectively; odds ratio (OR) 4.62, 95% confid ence interval (95% CI) 2.38 to 8.98). The most common form of cerebral pals y was spastic diplegia (incidence 22/80 (28%) v 5/79 (6%) in dexamethasone and placebo treated infants respectively; OR 4.45, 95% CI 1.95 to 10.15). D evelopmental delay was significantly more common in the dexamethasone treat ed group (44/80 (55%)) than in the placebo treated group (23/79 (29%); OR 2 .87, 95% CI 1.53 to 5.38). Dexamethasone treated infants had more periventr icular leucomalacia and less intraventricular haemorrhage in the neonatal p eriod than those in the placebo group, although these differences were not statistically significant. Eleven children with cerebral palsy had normal u ltrasound scans in the neonatal period; all 11 had received dexamethasone. Logistic regression analysis showed both periventricular leucomalacia and d rug assignment to dexamethasone to be highly significant predictors of abno rmal neurological outcome. Conclusions-A three day course of dexamethasone administered shortly after birth in preterm infants with respiratory distress syndrome is associated w ith a significantly increased incidence of cerebral palsy and developmental delay.