Background: High-dose dexamethasone (DXM) treatment of preterms at risk of bronchopulmonary dysplasia leads to a deterioration in quality of their general movements (GMs). It is unknown whether low-dose DXM affects GM quality similarly. Objectives: To assess the effect of low-dose DXM treatment on the quality of GMs and fidgety GMs (FMs). Methods: A prospective study of preterms admitted to our NICU between 2010 and 2012, and treated with DXM (starting dose 0.25 mg/kg/day). We assessed GM/FM quality and calculated their motor optimality score (MOS) before, during, and after treatment up to 3 months postterm. Neurological follow-up was performed between 12 and 36 months. We related risk factors with infants' GM trajectories and MOSs. At 3 months we compared the MOSs of low-dose DXM infants and a historical cohort of infants treated with high-dose DXM or hydrocortisone. Results: 17 infants were included. GM/FM quality improved in 9 out of 13 initially abnormal infants (p = 0.004). Shorter periods of mechanical ventilation and higher birth weights were associated with better GM trajectories (p = 0.032 and p = 0.042, respectively). Infants starting treatment later had higher MOSs on day 7 (p = 0.047). Low-dose DXM infants had higher MOSs than high-dose DXM infants (β = -0.535; 95% CI -0.594 to -0.132; p = 0.003). Out of 17 infants, 2 died, 14 developed normally, and 1 developed with mild neurodevelopmental impairments. Infants whose GMs/FMs remained normal or improved had better outcomes than infants whose GMs/FMs remained abnormal (p = 0.019). Conclusions: Out of the 17 infants treated with low-dose DXM, 2 died. Of the surviving infants, neurological functioning improved with the majority having normal neurodevelopment at the age of 12-36 months.

Keywords:
Dexamethasone, Bronchopulmonary dysplasia, General movements
1.
Watterberg KL, American Academy of Pediatrics. Committee on Fetus and Newborn: Policy statement - postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia. Pediatrics 2010;126:800-808.
2.
Malloy C, Hilal K, Rizvi Z, Weiss M, Muraskas J: A prospective, randomized, double-masked trial comparing low dose to conventional dose dexamethasone in neonatal chronic lung disease. Internet J Pediatr Neonatol 2004;5(1). http://ispub.com/IJPN.
3.
Onland W, De Jaegere AP, Offringa M, van Kaam AH: Effects of higher versus lower dexamethasone doses on pulmonary and neurodevelopmental sequelae in preterm infants at risk for chronic lung disease: a meta-analysis. Pediatrics 2008;122:92-101.
4.
Doyle LW, Davis PG, Morley CJ, McPhee A, Carlin JB, DART Study Investigators: Outcome at 2 years of age of infants from the DART study: a multicenter, international, randomized, controlled trial of low-dose dexamethasone. Pediatrics 2007;119:716-721.
5.
Stark AR, Carlo WA, Vohr BR, Papile LA, Saha S, Bauer CR, Oh W, Shankaran S, Tyson JE, Wright LL, Poole WK, Das A, Stoll BJ, Fanaroff AA, Korones SB, Ehrenkranz RA, Stevenson DK, Peralta-Carcelen M, Wilson-Costello DE, Bada HS, Heyne RJ, Johnson YR, Lee KG, Steichen JJ, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network: Death or neurodevelopmental impairment at 18 to 22 months corrected age in a randomized trial of early dexamethasone to prevent death or chronic lung disease in extremely low birth weight infants. J Pediatr 2014;164:34-39.e2.
6.
Einspieler C, Prechtl HF, Ferrari F, Cioni G, Bos AF: The qualitative assessment of general movements in preterm, term and young infants - review of the methodology. Early Hum Dev 1997;50:47-60.
7.
Ferrari F, Cioni G, Einspieler C, Roversi MF, Bos AF, Paolicelli PB, Ranzi A, Prechtl HF: Cramped synchronized general movements in preterm infants as an early marker for cerebral palsy. Arch Pediatr Adolesc Med 2002;156:460-467.
8.
Prechtl HF, Einspieler C, Cioni G, Bos AF, Ferrari F, Sontheimer D: An early marker for neurological deficits after perinatal brain lesions. Lancet 1997;349:1361-1363.
9.
Bos AF, Martijn A, van Asperen RM, Hadders-Algra M, Okken A, Prechtl HF: Qualitative assessment of general movements in high-risk preterm infants with chronic lung disease requiring dexamethasone therapy. J Pediatr 1998;132:300-306.
10.
Bos AF, Dibiasi J, Tiessen AH, Bergman KA: Treating preterm infants at risk for chronic lung disease with dexamethasone leads to an impaired quality of general movements. Biol Neonate 2002;82:155-158.
11.
Karagianni P, Tsakalidis C, Kyriakidou M, Mitsiakos G, Chatziioanidis H, Porpodi M, Evangeliou A, Nikolaides N: Neuromotor outcomes in infants with bronchopulmonary dysplasia. Pediatr Neurol 2011;44:40-46.
12.
Ehrenkranz RA, Walsh MC, Vohr BR, Jobe AH, Wright LL, Fanaroff AA, Wrage LA, Poole K, National Institutes of Child Health and Human Development Neonatal Research Network: Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005;116:1353-1360.
13.
Touwen BCL: Neurological development in infancy. Clin Dev Med 1976;58:1-150.
14.
De Vries NK, Erwich JJ, Bos AF: General movements in the first fourteen days of life in extremely low birth weight infants. Early Hum Dev 2008;84:763-768.
15.
Bruggink JL, Einspieler C, Butcher PR, Stremmelaar EF, Prechtl HF, Bos AF: Quantitative aspects of the early motor repertoire in preterm infants: do they predict minor neurological dysfunction at school age? Early Hum Dev 2009;85:25-36.
16.
Hitzert MM, Benders MJ, Roescher AM, van Bel F, de Vries LS, Bos AF: Hydrocortisone vs. dexamethasone treatment for bronchopulmonary dysplasia and their effects on general movements in preterm infants. Pediatr Res 2012;71:100-106.
17.
De Vries NK, Bos AF: The quality of general movements in the first ten days of life in preterm infants. Early Hum Dev 2010;86:225-229.
18.
Powell K, Kerkering KW, Barker G, Rozycki HJ: Dexamethasone dosing, mechanical ventilation and the risk of cerebral palsy. J Matern Fetal Neonatal Med 2006;19:43-48.
19.
Wilson-Costello D, Walsh MC, Langer JC, Guillet R, Laptook AR, Stoll BJ, Shankaran S, Finer NN, Van Meurs KP, Engle WA, Das A, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network: Impact of postnatal corticosteroid use on neurodevelopment at 18-22 months' adjusted age: effects of dose, timing, and risk of bronchopulmonary dysplasia in extremely low birth weight infants. Pediatrics 2009;123:e430-e437.
20.
Onland W, Offringa M, De Jaegere AP, van Kaam AH: Finding the optimal postnatal dexamethasone regimen for preterm infants at risk of bronchopulmonary dysplasia: a systematic review of placebo-controlled trials. Pediatrics 2009;123:367-377.
21.
Odd DE, Armstrong DL, Teele RL, Kuschel CA, Harding JE: A randomized trial of two dexamethasone regimens to reduce side effects in infants treated for chronic lung disease of prematurity. J Paediatr Child Health 2004;40:282-289.
22.
Doyle LW, Davis PG, Morley CJ, McPhee A, Carlin JB, DART Study Investigators: Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: a multicenter, international, randomized, controlled trial. Pediatrics 2006;117:75-83.
23.
Yates HL, Newell SJ: Minidex: very low dose dexamethasone (0.05 mg/kg/day) in chronic lung disease. Arch Dis Child Fetal Neonatal Ed 2011;96:F190-F194.
24.
Zahed-Cheikh M, Brevaut-Malaty V, Busuttil M, Monnier AS, Roussel M, Gire C: Comparative analysis of perinatal and postnatal factors, and general movement in extremely preterm infants. Brain Dev 2011;33:656-665.
25.
Pogribna U, Yu X, Burson K, Zhou Y, Lasky RE, Narayana PA, Parikh NA: Perinatal clinical antecedents of white matter microstructural abnormalities on diffusion tensor imaging in extremely preterm infants. PLoS One 2013;8:e72974.
26.
Armstrong DL, Penrice J, Bloomfield FH, Knight DB, Dezoete JA, Harding JE: Follow-up of a randomised trial of two different courses of dexamethasone for preterm babies at risk of chronic lung disease. Arch Dis Child Fetal Neonatal Ed 2002;86:F102-F107.
© 2014 S. Karger AG, Basel
2014
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