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Effect of cumulative dexamethasone dose in preterm infants on neurodevelopmental and growth outcomes: a Western Australia experience
  1. Ashok Kumar Buchiboyina1,
  2. Chi Seong Andrew Yip2,
  3. Rolland Kohan3,4,
  4. Elizabeth A Nathan5,
  5. Damber Shrestha3,
  6. Jonathon Davis3,6,
  7. Xiaowei Wang7,
  8. Mary Sharp3,4,6
  1. 1Department of Neonatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  2. 2Perth Children's Hospital, Nedlands, Perth, Australia
  3. 3Department of Neonatology, King Edward Memorial Hospital for Women and Newborns, Perth, Western Australia, Australia
  4. 4Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia
  5. 5Women and Infants Research Foundation, Subiaco, Western Australia, Australia
  6. 6Department of Neonatology, Perth Children's Hospital, Nedlands, Perth, Australia
  7. 7Royal Perth Hospital, Victoria Square, Perth, Australia
  1. Correspondence to Dr Ashok Kumar Buchiboyina, Department of Neonatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; ashok.buchiboyina{at}health.wa.gov.au

Abstract

Objective Comparing the long-term neurodevelopmental and growth outcomes of lower and higher cumulative dexamethasone exposure in preterm infants ventilated for a minimum cumulative duration of 7 days.

Design A retrospective cohort medical chart review of infants born in Western Australia <29 weeks’ gestation between January 2007 and May 2016 who were mechanically ventilated >7 days.

Intervention No dexamethasone (controls) or a total cumulative dexamethasone dose of <2 mg/kg (lower) and ≥2 mg/kg (higher).

Main outcome measures Long-term disability at 2 and 5 years and growth measurement outcomes at 2 years of age.

Results Dexamethasone was given to 104 infants (66 with cumulative dose <2 mg/kg; 38 with cumulative dose ≥2 mg/kg), and 324 infants were controls. There was no difference in odds of long-term disability in infants with any dexamethasone exposure compared with controls (aOR: 0.90, 95% CI 0.34 to 2.02, p=0.784). No difference in long-term disability was found between the lower and higher groups (p=0.494). The prevalence of cerebral palsy (Gross Motor Functional Classification System level ≥2) between the control, lower and high-dose groups did not differ significantly (5.8% vs 4.0% vs 0%). The higher dose group had lower mean weight z-score (mean effect: −0.83, 95% CI: −1.54 to −0.01, p=0.023), height z-score (mean effect: −0.63, 95% CI: −12.5 to −0.01, p=0.048) and head circumference z-score (mean effect: −0.65, 95% CI: −1.25 to −0.05, p=0.035) compared with controls.

Conclusions In our cohort, dexamethasone use was not associated with increased odds of long-term disability. Dexamethasone use was associated with lower growth measurements compared with controls.

  • neonatology
  • neurodisability
  • growth
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Footnotes

  • Contributors AKB and CSAY conceptualised and designed the study, collected data, carried out the analysis, drafted the initial manuscript, and reviewed and revised the manuscript. RK, JD and MS conceptualised and designed the study, collected data, carried out the analysis, and reviewed and revised the manuscript. EAN and DS carried out the statistical analysis and reviewed and revised the manuscript. XW conceptualised and designed the study and collected data. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by King Edward Memorial Hospital for Women research ethics committee (Quality Activity no: 21996).

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article.

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