The use of two or more courses of low-dose systemic dexamethasone to extubate ventilator-dependent preterm neonates may be associated with a higher prevalence of cerebral palsy at two years of corrected age.

Autor: Rocha G; Department of Neonatology, Centro Hospitalar e Universitário de São João, Porto, Portugal. Electronic address: gusrocha@sapo.pt., Calejo R; Department of Neonatology, Centro Hospitalar e Universitário de São João, Porto, Portugal., Arnet V; Department of Neonatology, Centro Hospitalar e Universitário de São João, Porto, Portugal., de Lima FF; Department of Neonatology, Centro Hospitalar e Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal., Cassiano G; Maternity Dr Alfredo da Costa, Centro Hospitalar Lisboa Central, Lisbon, Portugal., Diogo I; Maternity Dr Alfredo da Costa, Centro Hospitalar Lisboa Central, Lisbon, Portugal., Mesquita J; Maternity Dr Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal., Mimoso G; Maternity Dr Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal., Proença E; Department of Neonatology, Centro Hospitalar e Universitário de Santo António, Porto, Portugal., Carvalho C; Department of Neonatology, Centro Hospitalar e Universitário de Santo António, Porto, Portugal., Pinto CG; Department of Neonatology, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal., Salazar A; Department of Neonatology, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal., Aguiar M; Department of Neonatology, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal., Silva A; Department of Neonatology, Hospital de Braga, Braga, Portugal., Barroso A; Department of Neonatology, Hospital de Braga, Braga, Portugal., Quintas C; Department of Neonatology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
Jazyk: angličtina
Zdroj: Early human development [Early Hum Dev] 2024 Jul; Vol. 194, pp. 106050. Date of Electronic Publication: 2024 May 20.
DOI: 10.1016/j.earlhumdev.2024.106050
Abstrakt: Background: Our objective was to determine whether the use of two or more courses of low-dose systemic dexamethasone for extubation of ventilator-dependent preterm infants after the first week of life, as proposed in the DART study, is associated with greater neurodevelopmental harm at two years of corrected age, compared to a single course.
Methods: Retrospective review at seven level III neonatal intensive care units. Preterm infants who underwent only one course of systemic dexamethasone for extubation were grouped into DART-1; those who underwent two or more courses were grouped into DART-2. Data and outcomes of infants in DART-2 were compared with those in DART-1.
Results: 150 preterm infants were studied: 104 in DART-1 and 46 in DART-2. Patients in DART-2 had a lower gestational age (25 vs. 26 weeks, p = 0.031) and greater morbidity. The average dexamethasone cumulative dose for patients in DART-1 was 0.819 mg/kg, vs. 1.697 mg/kg for patients in DART-2. A total of 14 patients died. The neuromotor and neurosensory assessments at two years of corrected age revealed in the DART-2 survivors, after the multivariate analysis, a higher prevalence of cerebral palsy with functional motor class 2 (OR = 6.837; 95%CI: 1.054-44.337; p = 0.044) and ophthalmological problems requiring the use of glasses (OR = 4.157; 95%CI: 1.026-16.837; p = 0.046).
Conclusions: In this cohort, the use of more than one course of systemic dexamethasone in low doses for extubation of ventilator-dependent premature infants after the first week of life was associated, at two years of corrected age, with a higher prevalence of cerebral palsy with functional motor class 2 and ophthalmological problems requiring the use of glasses.
Competing Interests: Declaration of competing interest The authors disclose any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within that could inappropriately influence (bias) their work.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: