PMID- 35275165 OWN - NLM STAT- MEDLINE DCOM- 20220420 LR - 20220420 IS - 2574-3805 (Electronic) IS - 2574-3805 (Linking) VI - 5 IP - 3 DP - 2022 Mar 1 TI - Dexamethasone, Prednisolone, and Methylprednisolone Use and 2-Year Neurodevelopmental Outcomes in Extremely Preterm Infants. PG - e221947 LID - 10.1001/jamanetworkopen.2022.1947 [doi] LID - e221947 AB - IMPORTANCE: Practice variability exists in the use of corticosteroids to treat or prevent bronchopulmonary dysplasia in extremely preterm infants, but there is limited information on longer-term impacts. OBJECTIVE: To describe the use of corticosteroids in extremely preterm infants and evaluate the association with neurodevelopmental outcomes. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a secondary analysis of data from the Preterm Erythropoietin Neuroprotection (PENUT) randomized clinical trial, conducted at 19 participating sites and 30 neonatal intensive care units (NICUs) in the US. Inborn infants born between 24 0/7 and 27 6/7 weeks gestational age between December 2013 and September 2016 were included in analysis. Data analysis was conducted between February 2021 and January 2022. EXPOSURES: Cumulative dose of dexamethasone and duration of therapy for dexamethasone and prednisolone or methyl prednisolone were evaluated. MAIN OUTCOMES AND MEASURES: Demographic and clinical characteristics were described in infants who did or did not receive corticosteroids of interest and survived to discharge. Neurodevelopmental outcomes at 2 years of age were evaluated using the Bayley Scales of Infant Development-Third Edition (BSID-III) at corrected age 2 years. RESULTS: A total of 828 extremely preterm infants (403 [49%] girls; median [IQR] gestational age, 26 [25-27] weeks) born at 19 sites who survived to discharge were included in this analysis, and 312 infants (38%) were exposed to at least 1 corticosteroid of interest during their NICU stay, including 279 exposed to dexamethasone, 137 exposed to prednisolone or methylprednisolone, and 79 exposed to both. Exposed infants, compared with nonexposed infants, had a lower birth weight (mean [SD], 718 [168] g vs 868 [180] g) and were born earlier (mean [SD] gestational age, 25 [1] weeks vs 26 [1] weeks). The median (IQR) start day was 29 (20-44) days for dexamethasone and 53 (30-90) days for prednisolone or methylprednisolone. The median (IQR) total days of exposure was 10 (5-15) days for dexamethasone and 13 (6-25) days for prednisolone or methylprednisolone. The median (IQR) cumulative dose of dexamethasone was 1.3 (0.9-2.8) mg/kg. After adjusting for potential confounders, treatment with dexamethasone for longer than 14 days was associated with worse neurodevelopmental outcomes, with mean scores in BSID-III 7.4 (95% CI, -12.3 to -2.5) points lower in the motor domain (P = .003) and 5.8 (95% CI, -10.9 to -0.6) points lower in the language domain (P = .03), compared with unexposed infants. CONCLUSIONS AND RELEVANCE: These findings suggest that long duration and higher cumulative dose of dexamethasone were associated with worse neurodevelopmental scores at corrected age 2 years. Potential unmeasured differences in the clinical conditions of exposed vs unexposed infants may contribute to these findings. Improved standardization of treatment and documentation of indications would facilitate replication studies. FAU - Puia-Dumitrescu, Mihai AU - Puia-Dumitrescu M AD - Division of Neonatology, Department of Pediatrics, University of Washington, Seattle. FAU - Wood, Thomas R AU - Wood TR AD - Division of Neonatology, Department of Pediatrics, University of Washington, Seattle. FAU - Comstock, Bryan A AU - Comstock BA AD - Department of Biostatistics, University of Washington, Seattle. FAU - Law, Janessa B AU - Law JB AD - Division of Neonatology, Department of Pediatrics, University of Washington, Seattle. FAU - German, Kendell AU - German K AD - Division of Neonatology, Department of Pediatrics, University of Washington, Seattle. FAU - Perez, Krystle M AU - Perez KM AD - Division of Neonatology, Department of Pediatrics, University of Washington, Seattle. FAU - Gogcu, Semsa AU - Gogcu S AD - Division of Neonatology, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina. FAU - Mayock, Dennis E AU - Mayock DE AD - Division of Neonatology, Department of Pediatrics, University of Washington, Seattle. FAU - Heagerty, Patrick J AU - Heagerty PJ AD - Department of Biostatistics, University of Washington, Seattle. FAU - Juul, Sandra E AU - Juul SE AD - Division of Neonatology, Department of Pediatrics, University of Washington, Seattle. CN - Preterm Erythropoietin Neuroprotection (PENUT) Trial Consortium LA - eng GR - U01 NS077953/NS/NINDS NIH HHS/United States GR - U01 NS077955/NS/NINDS NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural DEP - 20220301 PL - United States TA - JAMA Netw Open JT - JAMA network open JID - 101729235 RN - 7S5I7G3JQL (Dexamethasone) RN - X4W7ZR7023 (Methylprednisolone) SB - IM MH - Adult MH - *Bronchopulmonary Dysplasia MH - Child MH - Child, Preschool MH - Cohort Studies MH - Dexamethasone/therapeutic use MH - Female MH - Humans MH - Infant MH - *Infant, Extremely Premature MH - Infant, Newborn MH - Male MH - Methylprednisolone PMC - PMC8917427 COIS- Conflict of Interest Disclosures: None reported. FIR - Wadhawan, Rajan IR - Wadhawan R FIR - Courtney, Sherry E IR - Courtney SE FIR - Robinson, Tonya IR - Robinson T FIR - Ahmad, Kaashif A IR - Ahmad KA FIR - Bendel-Stenzel, Ellen IR - Bendel-Stenzel E FIR - Baserga, Mariana IR - Baserga M FIR - LaGamma, Edmund F IR - LaGamma EF FIR - Downey, L Corbin IR - Downey LC FIR - Rao, Raghavendra IR - Rao R FIR - Fahim, Nancy IR - Fahim N FIR - Lampland, Andrea IR - Lampland A FIR - Frantz, Ivan D 3rd IR - Frantz ID 3rd FIR - Khan, Janine IR - Khan J FIR - Weiss, Michael IR - Weiss M FIR - Gilmore, Maureen M IR - Gilmore MM FIR - Ohls, Robin K IR - Ohls RK FIR - Lowe, Jean IR - Lowe J FIR - Srinivasan, Nishant IR - Srinivasan N FIR - Perez, Jorge E IR - Perez JE FIR - McKay, Victor IR - McKay V EDAT- 2022/03/12 06:00 MHDA- 2022/04/21 06:00 PMCR- 2022/03/11 CRDT- 2022/03/11 12:12 PHST- 2022/03/11 12:12 [entrez] PHST- 2022/03/12 06:00 [pubmed] PHST- 2022/04/21 06:00 [medline] PHST- 2022/03/11 00:00 [pmc-release] AID - 2789922 [pii] AID - zoi220087 [pii] AID - 10.1001/jamanetworkopen.2022.1947 [doi] PST - epublish SO - JAMA Netw Open. 2022 Mar 1;5(3):e221947. doi: 10.1001/jamanetworkopen.2022.1947.