Impact of postnatal corticosteroid use on neurodevelopment at 18 to 22 months' adjusted age: effects of dose, timing, and risk of bronchopulmonary dysplasia in extremely low birth weight infants.
Saved in:
| Title: | Impact of postnatal corticosteroid use on neurodevelopment at 18 to 22 months' adjusted age: effects of dose, timing, and risk of bronchopulmonary dysplasia in extremely low birth weight infants. |
|---|---|
| Authors: | Wilson-Costello D (AUTHOR), Walsh MC (AUTHOR), Langer JC (AUTHOR), Guillet R (AUTHOR), Laptook AR (AUTHOR), Stoll BJ (AUTHOR), Shankaran S (AUTHOR), Finer NN (AUTHOR), Van Meurs KP (AUTHOR), Engle WA (AUTHOR), Das A (AUTHOR), Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (CORPORATE AUTHOR) |
| Source: | Pediatrics. Mar2009, Vol. 123 Issue 3, pe430-7. 1p. |
| Abstract: | OBJECTIVE: Postnatal steroid use decreases lung inflammation but increases impairment. We hypothesized that increased dose is associated with increased neurodevelopmental impairment, lower postmenstrual age at exposure increases impairment, and risk of bronchopulmonary dysplasia modifies the effect of postnatal corticosteroid. METHODS: Steroid dose and timing of exposure beyond 7 days was assessed among 2358 extremely low birth weight infants nested in a prospective trial, with 1667 (84%) survivors examined at 18 to 22 months' postmenstrual age. Logistic regression tested the relationship between impairment (Bayley Mental Developmental Index/Psychomotor Developmental Index of <70, disabling cerebral palsy, or sensory impairment), total dose (tertiles: <0.9, 0.9-1.9, and >/=1.9 mg/kg), and postmenstrual age at first dose. Separate logistic regression tested effect modification according to bronchopulmonary dysplasia severity (Romagnoli risk > 0.5 as high risk, n = 2336 (99%) for days of life 4-7). RESULTS: Three hundred sixty-six (16%) neonates were steroid-treated (94% dexamethasone). Treated neonates were smaller and less mature; 72% of those treated were at high risk for bronchopulmonary dysplasia. Exposure was associated with neurodevelopmental impairment/death. Impairment increased with higher dose; 71% dead or impaired at highest dose tertile. Each 1 mg/kg dose was associated with a 2.0-point reduction on the Mental Developmental Index and a 40% risk increase for disabling cerebral palsy. Older age did not mitigate the harm. Treatment after 33 weeks' postmenstrual age was associated with greatest harm despite not receiving the highest dose. The relationship between steroid exposure and impairment was modified by the bronchopulmonary dysplasia risk, with those at highest risk experiencing less harm. CONCLUSIONS: Higher steroid dose was associated with increased neurodevelopmental impairment. There is no 'safe' window for steroid use in extremely low birth weight infants. Neonates with low bronchopulmonary dysplasia risk should not be exposed. A randomized trial of steroid use in infants at highest risk is warranted. [ABSTRACT FROM AUTHOR] |
| Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Psychology and Behavioral Sciences Collection |
| FullText | Text: Availability: 0 |
|---|---|
| Header | DbId: pbh DbLabel: Psychology and Behavioral Sciences Collection An: 105472520 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
| IllustrationInfo | |
| Items | – Name: Title Label: Title Group: Ti Data: Impact of postnatal corticosteroid use on neurodevelopment at 18 to 22 months' adjusted age: effects of dose, timing, and risk of bronchopulmonary dysplasia in extremely low birth weight infants. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Wilson-Costello+D%22">Wilson-Costello D</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Walsh+MC%22">Walsh MC</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Langer+JC%22">Langer JC</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Guillet+R%22">Guillet R</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Laptook+AR%22">Laptook AR</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Stoll+BJ%22">Stoll BJ</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Shankaran+S%22">Shankaran S</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Finer+NN%22">Finer NN</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Van+Meurs+KP%22">Van Meurs KP</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Engle+WA%22">Engle WA</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Das+A%22">Das A</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Eunice+Kennedy+Shriver+National+Institute+of+Child+Health+and+Human+Development+Neonatal+Research+Network%22">Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network</searchLink> (CORPORATE AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Pediatrics%22">Pediatrics</searchLink>. Mar2009, Vol. 123 Issue 3, pe430-7. 1p. – Name: Abstract Label: Abstract Group: Ab Data: OBJECTIVE: Postnatal steroid use decreases lung inflammation but increases impairment. We hypothesized that increased dose is associated with increased neurodevelopmental impairment, lower postmenstrual age at exposure increases impairment, and risk of bronchopulmonary dysplasia modifies the effect of postnatal corticosteroid. METHODS: Steroid dose and timing of exposure beyond 7 days was assessed among 2358 extremely low birth weight infants nested in a prospective trial, with 1667 (84%) survivors examined at 18 to 22 months' postmenstrual age. Logistic regression tested the relationship between impairment (Bayley Mental Developmental Index/Psychomotor Developmental Index of <70, disabling cerebral palsy, or sensory impairment), total dose (tertiles: <0.9, 0.9-1.9, and >/=1.9 mg/kg), and postmenstrual age at first dose. Separate logistic regression tested effect modification according to bronchopulmonary dysplasia severity (Romagnoli risk > 0.5 as high risk, n = 2336 (99%) for days of life 4-7). RESULTS: Three hundred sixty-six (16%) neonates were steroid-treated (94% dexamethasone). Treated neonates were smaller and less mature; 72% of those treated were at high risk for bronchopulmonary dysplasia. Exposure was associated with neurodevelopmental impairment/death. Impairment increased with higher dose; 71% dead or impaired at highest dose tertile. Each 1 mg/kg dose was associated with a 2.0-point reduction on the Mental Developmental Index and a 40% risk increase for disabling cerebral palsy. Older age did not mitigate the harm. Treatment after 33 weeks' postmenstrual age was associated with greatest harm despite not receiving the highest dose. The relationship between steroid exposure and impairment was modified by the bronchopulmonary dysplasia risk, with those at highest risk experiencing less harm. CONCLUSIONS: Higher steroid dose was associated with increased neurodevelopmental impairment. There is no 'safe' window for steroid use in extremely low birth weight infants. Neonates with low bronchopulmonary dysplasia risk should not be exposed. A randomized trial of steroid use in infants at highest risk is warranted. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
| PLink | https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=105472520 |
| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1542/peds.2008-1928 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 1 StartPage: e430 Titles: – TitleFull: Impact of postnatal corticosteroid use on neurodevelopment at 18 to 22 months' adjusted age: effects of dose, timing, and risk of bronchopulmonary dysplasia in extremely low birth weight infants. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Wilson-Costello D – PersonEntity: Name: NameFull: Walsh MC – PersonEntity: Name: NameFull: Langer JC – PersonEntity: Name: NameFull: Guillet R – PersonEntity: Name: NameFull: Laptook AR – PersonEntity: Name: NameFull: Stoll BJ – PersonEntity: Name: NameFull: Shankaran S – PersonEntity: Name: NameFull: Finer NN – PersonEntity: Name: NameFull: Van Meurs KP – PersonEntity: Name: NameFull: Engle WA – PersonEntity: Name: NameFull: Das A – PersonEntity: Name: NameFull: Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 03 Text: Mar2009 Type: published Y: 2009 Identifiers: – Type: issn-print Value: 00314005 Numbering: – Type: volume Value: 123 – Type: issue Value: 3 Titles: – TitleFull: Pediatrics Type: main |
| ResultId | 1 |
