Steroid Use in Preterm Infants May Cause Cerebral Palsy

Use of the steroid dexamethasone in preterm infants with respiratory distress syndrome is associated with a significantly increased incidence of cerebral palsy and developmental delay, according to new research.

Researchers compared a three-day course of dexamethasone with a placebo (saline) administered from before 12 hours of age in preterm infants, who were being treated for respiratory distress syndrome (RDS) and had received surfactant treatment.

RDS is a disorder that occurs in premature infants and is characterized by a deficiency of the surfactant coating the inner surface of the lungs, by failure of the lungs to expand and contract properly during breathing, and by the accumulation of a protein-containing film lining the alveoli and their ducts. A sufactant is a surface-active lipoprotein mixture which coats the alveoli of the lungs and prevents the collapse of the lungs.

According to researchers:

"Dexamethasone treatment was associated with an increased incidence of hypertension, hyperglycemia, and gastrointestinal hemorrhage and no reduction in either the incidence or severity of chronic lung disease or mortality."

In addition, there were no differences between the groups in terms of:

• Perinatal or neonatal course

• Antenatal steroid administration

• Severity of initial disease

• Major neonatal morbidity.

Dexamethasone treated children had a nearly 5-fold increased incidence of cerebral palsy and nearly a 3-fold increased risk of developmental delay.

Researchers note that eleven children with cerebral palsy had normal ultrasound scans and all 11 had received dexamethasone.

The study's authors conclude that "A three day course of dexamethasone administered shortly after birth in preterm infants with respiratory distress syndrome is associated with a significantly increased incidence of cerebral palsy and developmental delay."

Arch Dis Child Fetal Neonatal Ed November, 2000;83:F177-F181

Dangers of Long-term Steroid Use

Long-term use of even low doses of oral steroids, such as predsisone, is associated with a significantly increased risk of hip fracture and cataracts, according to new research.

• It is already known that higher doses of steroids pose risks, but it had been assumed that lower doses might be safe.

• Researchers used data on nearly 5,000 patients with rheumatoid arthritis who were taking 5 to 10 mg daily (avg. 6.8 mg) of prednisone.

• Prednisone use was associated with a doubling of the risk for hip fracture and a 2.5-fold increased risk of cataracts.

Long-term use of steroids are commonly employed in the treatment of a number of diseases, such as:

• Asthma

• Rheumatoid arthritis

• Crohn's disease and other inflammatory bowel disorders

One of the researchers, Dr. John B. Wong from Tufts-New England Medical Center in Boston, Massachusetts stated in comments to Reuters Health that he suspects that the same correlation found in this study would hold true for inhaled steroids, such as those commonly used long-term in asthmatics.

Meeting of the American College of Chest Physicians October 2000, San Francisco, California