Perinatal corticosteroids: Latent neurodevelopment of the preterm infant
Isabell Biene Purdy, PhD, NNP, CPNP, Emeritus Professor
- Sigma Affiliation
- Gamma Tau at-Large
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The purpose of this study was to evaluate potential relationships between perinatal dexamethasone treatment of premature infants and latent child development. Often, postnatal corticosteroid (PNS) is offered in the neonatal intensive care unit (NICU) to wean mechanical ventilation. Experts suggested minimizing PNS use after studies identified higher milligrams per kilogram (mg/kg) as a risk factor for adverse developmental outcomes. This study quantified fetal dexamethasone and cumulative perinatal dexamethasone by mg/kg exposure to accurately assess associations between steroid exposure and premature infant behavioral development.
This historical hospital-based cohort study identified PNS exposures among premature infants born between 1990–1998 and who were admitted to a public weeks gestational age at birth. Delivery-room logs and a proprietary locator search of national bases were conducted to locate 52 children of who 45 were enrolled using an approved protocol. Medical record data abstraction provided drug timing and dose. Steroid calculations, based upon actual maternal and fetal weights, determined fetal dose. To determine cumulative perinatal dexamethasone dose, the fetal and postnatal dexamethasone doses were added together. At 5 to 12 years of age, parent report of behavioral development was obtained with Vineland Adaptive Behavioral Scales (VABS) and Child Behavior Check Lists (CBCL). Child development outcomes were compared between high and low-no dose dexamethasone exposure groups: (1) >0.08mg/kg versus ≤0.08mg/kg); and (2) >0.2mg/kg versus ≤0.2mg/kg).
Although, levels of statistical significance would not be reached after adjusting for the multiple tests conducted on the primary hypotheses, associations of potential clinical import were seen between high fetal dexamethasone with low VABS overall, social and daily living, low CBCL total, social and activities competencies scores, and also greater internalizing and externalizing problems. High cumulative perinatal dexamethasone exposure was associated with low VABS overall and domain, low CBCL total and school competency scores, and greater social problems.
The results of this study highlight the importance of continued efforts to understand the relationships of perinatal steroids to latent child development of preterm infants and support the need for continued research in this area.
This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 3142536; ProQuest document ID: 305201585. The author still retains copyright.
This item has not gone through this repository's peer-review process, but has been accepted by the indicated university or college in partial fulfillment of the requirements for the specified degree.
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Perinatal Dexamethasone Treatements
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