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Postnatal corticosteroids and neurodevelopmental outcomes in extremely low birthweight or extremely preterm infants: 15-year experience in Victoria, Australia
  1. Jeanie Ling Cheong1,2,3,
  2. Peter Anderson2,4,
  3. Gehan Roberts2,5,
  4. Julianne Duff6,
  5. Lex W Doyle2,3,
  6. Victorian Infant Collaborative Study Group
  1. 1Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia
  2. 2Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  3. 3Obstetrics and Gynaecology Department, University of Melbourne, Parkville, Victoria, Australia
  4. 4Psychology Department, University of Melbourne, Parkville, Victoria, Australia
  5. 5Paediatrics Department, Royal Children's Hospital, Parkville, Victoria, Australia
  6. 6Royal Women's Hospital, Parkville, Victoria, Australia
  1. Correspondence to Jeanie Ling Cheong, Neonatal Services, Royal Women's Hospital, Level 7, Newborn Research, 20 Flemington Road, Parkville, Victoria 3052, Australia; jeanie.cheong{at}thewomens.org.au

Abstract

Objective Postnatal corticosteroids (PCS) are used to prevent or treat bronchopulmonary dysplasia (BPD) in extremely low birthweight (ELBW; <1000 g) or extremely preterm (EPT; <28 weeks) infants. In the early 2000s, concerns were raised about increased risks of cerebral palsy (CP) in association with PCS, which may have affected prescribing of PCS, and influenced rates of BPD, mortality or long-term neurosensory morbidity. Our aim was to determine the changes over time in the rates of PCS use and 2-year outcomes in ELBW/EPT infants in Victoria, Australia.

Design All ELBW or EPT infants born in Victoria, Australia in three distinct eras (1991–92, 1997 and 2005) who were alive at 7 days were included. Rates of PCS use, rates of BPD (oxygen dependency at 36 weeks' corrected age), death before 2 years of age, CP and major disability (any of moderate/severe CP, developmental quotient <−2 SD, blindness or deafness) were contrasted between cohorts.

Results The rate of PCS use and the dose prescribed diminished significantly in 2005 compared with earlier eras, but the rate of BPD rose. Non-significant changes in the rates of mortality over time were mirrored by non-significant changes in the rates of CP or major disability. Combined outcomes of mortality with either major disability or CP were similar over the three eras.

Conclusions PCS use decreased in 2005 compared with earlier eras, and was accompanied by a rise in BPD, with no significant changes in mortality or neurological morbidity.

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Footnotes

  • Collaborators Participants: Convenor; Lex W Doyle MD, FRACP. Collaborators (in alphabetical order); Peter J Anderson PhD Catherine Callanan RN, Elizabeth Carse FRACP, Margaret P Charlton M Ed Psych, Mary-Ann Davey PhD, Noni Davis FRACP, Julianne Duff FRACP, Rod Hunt PhD, FRACP, Cinzia de Luca PhD, Marie Hayes RN, Esther Hutchinson DPsychClinNeuro, Elaine Kelly MA, Marion McDonald RN, Gillian Opie FRACP, Gehan Roberts PhD, FRACP, Michael Stewart FRACP, Andrew Watkins FRACP, Amanda Williamson MA, Heather Woods RN.

  • Funding NHMRC project grants.

  • Competing interests None.

  • Ethics approval Royal Women's Hospital, Mercy Hospital for Women, Monash Medical Centre.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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