期刊
PEDIATRICS
卷 121, 期 2, 页码 289-296出版社
AMER ACAD PEDIATRICS
DOI: 10.1542/peds.2007-1103
关键词
prenatal glucocorticoid treatment; dexamethasone; betamethasone; extremely low birth weight; neurodevelopmental outcome
类别
资金
- NICHD NIH HHS [U10 HD27856, U10 HD27853, U10 HD27851, U10 HD21385, U10 HD21364, U10 HD21373, U10 HD36790, U10 HD40461, U10 HD40492, U10 HD40521, U10 HD40689, U10 HD34216, U10 HD27904, U10 HD27871, U10 HD27880] Funding Source: Medline
OBJECTIVE. We compared the development of adverse neurodevelopmental outcomes at corrected ages of 18 to 22 months for extremely low birth weight infants exposed prenatally to dexamethasone, betamethasone, or no steroid. METHODS. Study infants were extremely low birth weight (401-1000 g) infants who were in the care of National Institute of Child Health and Human Development Neonatal Research Network centers between January 1, 2002, and April 30, 2003; they were assessed neurodevelopmentally at corrected ages of 18 to 22 months. Outcomes were defined as Bayley Scales of Infant Development-II Mental Development Index of < 70, Bayley Scales of Infant Development-II Psychomotor Development Index of < 70, bilateral blindness, bilateral hearing aid use, cerebral palsy, and neurodevelopmental impairment. Neurodevelopmental impairment was defined as >= 1 of the aforementioned outcomes. RESULTS. A total of 1124 infants met entry criteria. There were no statistically significant associations between prenatal dexamethasone exposure and any follow-up outcome, compared with no prenatal steroid exposure. Prenatal betamethasone exposure was associated with reduced risks of hearing impairment and neurodevelopmental impairment and with increased likelihood of unimpaired status, compared with no prenatal steroid exposure. Compared with betamethasone, dexamethasone was associated with a trend for increased risk of Psychomotor Development Index of < 70, increased risk of hearing impairment, and decreased likelihood of unimpaired status. CONCLUSIONS. Prenatal betamethasone exposure was associated with increased likelihood of unimpaired neurodevelopmental status and reduced risk of hearing impairment at corrected ages of 18 to 22 months among extremely low birth weight infants, compared with prenatal dexamethasone exposure or no prenatal steroid exposure. Pending a randomized, clinical trial, it may be in the best interests of infants to receive betamethasone, rather than dexamethasone, when possible.
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