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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:
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Perinatal or neonatal course
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Antenatal steroid administration
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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.
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It is already known that higher doses of steroids pose risks,
but it had been assumed that lower doses might be safe.
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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:
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Asthma
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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
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