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Neurodevelopmental defects after steroid treatment of premature lung disease
  1. K E Johnson
  1. Paediatric Specialist Registrar, Darent Valley Hospital, Dartford, UK; donniebirdhotmail.com

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There has been much controversy in recent years regarding the early use of postnatal corticosteroids to treat preterm infants with respiratory distress syndrome (RDS). Short term respiratory benefits must be weighed against the potential for detrimental neurodevelopmental effects.

This study reports follow up data on growth, neurological and motor function, cognition, and school performance of two groups of ex-preterm infants assessed when reaching school age. In the original study, 262 preterm infants with severe RDS were randomly allocated to receive either early postnatal dexamethasone or placebo. The study had reported a significant reduction in chronic lung disease in the dexamethasone treated group without excess mortality. The children followed up at school age were the survivors of the original study. At school age (mean 8 years) children in the dexamethasone treated group were significantly shorter and had smaller head circumferences than the placebo treated controls. In addition, dexamethasone treated children had significantly poorer performance in most skill areas including motor coordination, visual motor integration, and IQ.

This follow up study supports the view that early postnatal corticosteroids cannot be recommended for the routine treatment of RDS or the prevention of chronic lung disease of prematurity.

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