Effect of cumulative dexamethasone dose in preterm infants on neurodevelopmental and growth outcomes: a Western Australia experience

2020 ◽  
Vol 106 (1) ◽  
pp. 69-75
Author(s):  
Ashok Kumar Buchiboyina ◽  
Chi Seong Andrew Yip ◽  
Rolland Kohan ◽  
Elizabeth A Nathan ◽  
Damber Shrestha ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Western Australia ◽  
Cumulative Dose ◽  
System Level ◽  
High Dose ◽  
Z Score ◽  
Lower Growth ◽  
Growth Measurement ◽  
Growth Outcomes

ObjectiveComparing the long-term neurodevelopmental and growth outcomes of lower and higher cumulative dexamethasone exposure in preterm infants ventilated for a minimum cumulative duration of 7 days.DesignA retrospective cohort medical chart review of infants born in Western Australia <29 weeks’ gestation between January 2007 and May 2016 who were mechanically ventilated >7 days.InterventionNo dexamethasone (controls) or a total cumulative dexamethasone dose of <2 mg/kg (lower) and ≥2 mg/kg (higher).Main outcome measuresLong-term disability at 2 and 5 years and growth measurement outcomes at 2 years of age.ResultsDexamethasone was given to 104 infants (66 with cumulative dose <2 mg/kg; 38 with cumulative dose ≥2 mg/kg), and 324 infants were controls. There was no difference in odds of long-term disability in infants with any dexamethasone exposure compared with controls (aOR: 0.90, 95% CI 0.34 to 2.02, p=0.784). No difference in long-term disability was found between the lower and higher groups (p=0.494). The prevalence of cerebral palsy (Gross Motor Functional Classification System level ≥2) between the control, lower and high-dose groups did not differ significantly (5.8% vs 4.0% vs 0%). The higher dose group had lower mean weight z-score (mean effect: −0.83, 95% CI: −1.54 to −0.01, p=0.023), height z-score (mean effect: −0.63, 95% CI: −12.5 to −0.01, p=0.048) and head circumference z-score (mean effect: −0.65, 95% CI: −1.25 to −0.05, p=0.035) compared with controls.ConclusionsIn our cohort, dexamethasone use was not associated with increased odds of long-term disability. Dexamethasone use was associated with lower growth measurements compared with controls.

scholarly journals Early High-dose Caffeine Improves Respiratory Outcomes in Preterm Infants

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 501
Author(s):  
Vineet Lamba ◽  
Oscar Winners ◽  
Prem Fort
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Regression Models ◽  
High Dose ◽  
Long Term Outcomes ◽  
Logistic Regression Models ◽  
Caffeine Citrate ◽  
Timing Of Initiation ◽  
Respiratory Outcomes

The objective of the study is to determine if early high-dose caffeine (HD) therapy is associated with shorter duration of mechanical ventilation, bronchopulmonary dysplasia (BPD), or decreased need for mechanical ventilation. We conducted a single center, retrospective cohort study of 273 infants less than 32 weeks gestational age (GA). Infants receiving early HD (10 mg/kg/day maintenance) caffeine citrate started within 24 h of life were compared with those receiving LD (6 mg/kg/day) with variable timing of initiation using linear and logistic regression models. The infants in the early HD group had 91.4 (95% confidence interval (CI): −166.6, −16.1; p = 0.018) less hours of mechanical ventilation up to 36 weeks PMA or discharge as compared with the LD group. Moreover, infants in the HD group had 0.37 (95% CI: 0.14, 0.97; p = 0.042) times lower odds of developing moderate/severe BPD compared with the LD group. Infants receiving early HD caffeine had improved respiratory outcomes with no increase in measured comorbidities. Large prospective studies are needed to determine the long-term outcomes of using high-dose caffeine prophylaxis for preterm infants.

Long-Term Follow-Up of Treatment Outcome and Prognosis in 96 Chinese Children with Acute Myeloid Leukemia: A Single Center Experience.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4560-4560
Author(s):  
Yongmin Tang ◽  
Xiaojun Xu ◽  
Hua Song ◽  
Shilong Yang ◽  
Shuwen Shi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Cumulative Dose ◽  
Chinese Children ◽  
High Dose ◽  
Free Survival ◽  
The Past ◽  
Hla Dr ◽  
Childhood Aml

Abstract Owing to the intensification of chemotherapy, the complete remission (CR), overall survival (OS), disease free survival (DFS) and event free survival (EFS) rates in childhood AML have been significantly improved during the past two decades in western countries. However, reports on the long-term outcome of this disease in Chinese children remain to be very limited. Objectives The aims of this study were to investigate the outcome and prognostic factors in Chinese childhood AML treated in our hospital during the past 7 years and to provide the basis for further improvement of outcome in children with AML. Methods From April 1998 to August 2005, 96 children (51 boys and 45 girls, aged 1.5 ~ 16.1 yrs with a median age of 9) with de novo AML diagnosed in our hospital based on MICM criteria were enrolled into this study. In total, 57 patients with non-APL AML were treated with the induction therapy of daunorubicin (maximum total cumulative dose 360 mg/M2) + Ara-C (DA) or homoharringtonine + Ara-C (HA), post-remission therapy with high-dose (1~2 g/M2 q12h for 6 doses) Ara-C containing regimens for three-month courses, and low-dose therapy with daunorubicin, homoharringtonine, etoposide (maximum total cumulative dose 1800 mg/M2) and Ara-C for three-month courses, followed by maintenance therapy for a total of 2~2.5 yrs. The 39 patients with APL were treated with all-trans retinoic acid (ATRA) and drugs above. Results Out of 96 patients, 86 children (89.6%) achieved CR. The estimated OS rates at three, five and seven years were (67.2±5.5)%, (58.1±6.4)% and (49.6±8.0)%, respectively, while the EFS rates were (52.3±5.8)%, (47.6±6.2)% and (47.6±6.2)%, and the DFS rates were (55.9±6.0)%, (50.7±6.4)% and (50.7±6.4)%, respectively. Univariant analysis showed that the variables predicted higher CR rates included the WBC counts (93.2% for patients &lt; 100 × 109/L vs 50.0% for those ≥ 100 × 109/L, P = 0.004) at diagnosis, and the blasts (100% for patients without blasts vs 85.2% for those with blasts, P = 0.023) in the peripheral blood. The variables predicted longer survival duration included WBC counts ((49.1±6.5)% of 5yr EFS for patients &lt; 100 × 109/L vs (33.3±18.0)% for those ≥ 100 × 109/L, P = 0.022) at diagnosis, FAB subtypes ((55.9±9.7)% for M3 vs (40.4±7.7)% for non-M3, P =0.048), course numbers [(76.0±12.2)% of 5-yr ESF for 1 course vs (31.1±9.0)% for more than 2 courses, P = 0.026) for achieving CR, CD38+ ((57.9± 7.3)% for CD38+ vs (16.7%± 10.8)% for CD38−, P = 0.005), CD14− ((49.9± 7.3)% for CD14− vs (21.5%± 14.2)% for CD14+, P = 0.001), CD34− ((54.7± 9.7)% for CD34− vs (32.6%± 8.8)% for CD34+, P = 0.038) and HLA-DR- ((57.7± 17.7)% for HLA-DR- vs (39.9%± 7.4)% for HLA-DR+, P = 0.024). 17 patients lost follow-up. The total cumulative relapse rate was 31.6% (25/79) with all BM relapse. The total treatment related modality rate was 5.3%. No secondary malignancy case was identified. Conclusions DA-based induction and high dose Ara-C-based post-remission treatment are effective to improve the CR rate and long-term survival in Chinese children with AML. The results are comparable to those reported in western countries. Initial WBC counts, early response to chemotherapy, FAB subtypes and some immunological markers are proved to be the significant prognostic factors for childhood AML under our current protocol.

Caffeine Therapy in Preterm Infants: The Dose (and Timing) Make the Medicine

2019 ◽  
Vol 38 (6) ◽  
pp. 365-374
Author(s):  
Sara E. Rostas ◽  
Christopher McPherson
Keyword(s):  
Preterm Infants ◽  
Current Evidence ◽  
High Dose ◽  
Dosing Regimens ◽  
Continued Use ◽  
Initiation Of Therapy ◽  
Timing Of Initiation ◽  
Apnea Of Prematurity ◽  
Robust Evidence

Caffeine is one of the most commonly utilized medications in the NICU. In preterm infants, short-term and long-term pulmonary and neurodevelopmental benefits of therapy are well documented in the literature. While robust evidence supports the use of standard doses of caffeine for apnea of prematurity or to facilitate successful extubation, much remains unknown regarding the boundaries of efficacy and safety for this common therapeutic agent. Escalating dosing regimens seem to provide additional benefit in select infants, but grave toxicity has also been documented with early utilization of high-dose caffeine. Conflicting data exist surrounding the ideal timing of initiation of therapy. Even the widely adhered to discontinuation point has been challenged by data supporting continued use. Until robust data definitively support change, practice should align with current evidence defining clear, safe, and efficacious dosing and timing of caffeine therapy.

scholarly journals SP3 Evaluating the impact of concentrated standardised parenteral nutrition on growth of preterm infants

2020 ◽  
Vol 105 (9) ◽  
pp. e2.1-e2
Author(s):  
Lucy Stachow ◽  
T’ng Chang Kwok ◽  
Ramune Snuggs ◽  
Rowan Toyer ◽  
Emmanuel Oyewole ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Preterm Infants ◽  
Gestational Age ◽  
Head Circumference ◽  
Growth Failure ◽  
Neonatal Unit ◽  
Extremely Low Birth Weight ◽  
Z Score ◽  
Early Nutrition ◽  
Growth Outcomes

Background and AimConcentrated standardised parenteral nutrition (CSPN) may reduce the delay in commencing parenteral nutrition (PN) in preterm infants compared with conventional individualised PN. Optimisation of early nutrition, with emphasis on earlier commencement of PN to include amino acids and addition of lipids within 24 hours of birth, ameliorates early postnatal growth failure.1 2 Cumulative nutritional deficit often seen in significantly preterm infants may lead to poor neurodevelopmental outcome.3 4 CSPN was introduced in our neonatal unit in December 2017 with the objective of improving early nutrition. The aim of this service evaluation was to assess the suitability of CSPN and its impact on the growth of preterm infants in our tertiary level neonatal unit.MethodsIn December 2017, the neonatal PN provided was switched from individualised PN to CSPN based on a modified ‘SCAMP’ regimen. Retrospective and prospective growth parameter data was collected for infants receiving PN within 24 hours of birth born between September to November 2017 (individualised PN arm) and from September to November 2018 (CSPN arm). Infants were excluded if they died or transferred out of the local neonatal service before day 28 of life, or died before transitioning from PN to full enteral feeds. Weight and head circumference at birth, 28 days old and 36 weeks corrected gestation/discharge were converted to z scores using the LMS method. The Mann-Whitney test was used to compare continuous data. Annual PN expenditure, and wastage of ordered PN, before and after the switch to CSPN, was calculated using the pharmacy stock management system, pharmacist and finance records.Results20 infants (mean gestational age 28 weeks) and 21 infants (mean gestational age 29.6 weeks) were included in the CSPN and individualised PN groups respectively. There were no differences in demographic data of each group. CSPN was commenced earlier (median 8 hours old (n=20)) than individualised PN (median 25 hours old (n=19)), (U=42, p<0.0001). There was no statistical difference in the change in weight z score from birth at 28 days old (median -0.47 (n=20) CSPN vs -0.66 (n=19) individualised PN, U=178.5, p=0.75) and at 36 weeks corrected gestation/discharge (median -0.72 (n=20) CSPN vs -0.86 (n=21) individualised PN, U=106, p=0.7). There was insufficient data collected to analyse effect on head circumference. Replacing individualised PN with CSPN resulted in a 37% reduction in procurement costs, despite an increase in the wastage of ordered PN from 7.2% to 8.5%.ConclusionA PN strategy using concentrated standardised PN can be implemented successfully in a tertiary neonatal unit setting in the United Kingdom and allows earlier commencement of PN. Use of CSPN appeared to have no adverse effect on weight gain, although small sample size may account for the lack of statistical significance in improvement of weight z score seen. Improved rates of head circumference documentation for our patients are required. Introducing CSPN resulted in a considerable reduction in procurement costs, and identifying strategies to minimise wastage of CSPN bags would further improve cost-effectiveness.ReferencesMorgan C, McGowan P, Herwitker S, et al. Postnatal head growth in preterm infants: a randomised controlled parenteral nutrition study. Pediatrics 2014;133:e120–8.Moyses HE, Johnson MJ, Leaf AA, et al. Early parenteral nutrition and growth outcomes in preterm infants: a systematic review and meta-analysis. Am J Clin Nutr 2013;97:816–26.Ehrenkranz RA, Dusick AM, Vohr BR, et al. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006;117:1253–61.Dusick AM, Poindexter BB, Ehrenkranz RA, et al. Growth failure in the preterm infant: can we catch up?Semin Perinatol 2003;27:302–10.

scholarly journals Low- vs. high-dose radiotherapy in Graves’ ophthalmopathy: a retrospective comparison of long-term results

2021 ◽  
Author(s):  
Thomas Weissmann ◽  
Sebastian Lettmaier ◽  
Anna-Jasmina Donaubauer ◽  
Christoph Bert ◽  
Manfred Schmidt ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Treatment Response ◽  
Cumulative Dose ◽  
Clinical Symptoms ◽  
Long Term Results ◽  
High Dose ◽  
Ocular Motility ◽  
Graves Ophthalmopathy

Abstract Purpose Radiotherapy represents an effective treatment option in Graves’ ophthalmopathy (GO), leading to palliation of clinical symptoms. However, there are only a limited number of trials comparing the effectiveness of low- vs. high-dose radiotherapy. Methods We analyzed 127 patients treated with radiotherapy for stage 3/4 GO (NOSPECS classification). Patients were treated with single doses of 2.0 Gy (cumulative dose 20 Gy) until 2007, afterwards a single dose of 0.8 Gy (cumulative dose 4.8 Gy) was applied. With a median follow-up-time of 9.0 years, the treatment efficacy (overall improvement, sense of eye pressure, lid edema, ocular motility, exophthalmos, subjective vision, and diplopia) and adverse effects were analyzed by a standardized survey. Results Overall, 63.8% described improvement of symptoms after radiotherapy. No significant differences in overall treatment response and improvement of main outcome measures between low- or high-dose radiotherapy treatments are detectable, while low-dose radiotherapy leads significantly more often to retreatment (13.1% vs. 1.7%, p = 0.016). The main independent predictor of treatment response is the presence of lid edema (odds ratio, OR, 3.53; p = 0.006). Conclusion At long-term follow-up, the majority of patients reported palliation of symptoms with limited adverse effects, suggesting clinical effectiveness of radiotherapy for amelioration of GO symptoms independent of low- or high-dose radiotherapy.

scholarly journals Growth of Very Preterm Infants in a Low-Resourced Rural Setting after Affiliation with a Human Milk Bank

Children ◽  
2022 ◽  
Vol 9 (1) ◽  
pp. 80
Author(s):  
Chia-Huei Chen ◽  
Hui-Ya Chiu ◽  
Szu-Chia Lee ◽  
Hung-Yang Chang ◽  
Jui-Hsing Chang ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Rural Areas ◽  
Z Score ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Growth Outcomes ◽  
Milk Bank ◽  
Human Milk Bank ◽  
Milk Banks

The extrauterine growth restriction (EUGR) of very preterm infants has been associated with long-term complications and neurodevelopmental problems. EUGR has been reported at higher rates in low resource settings. There is limited research investigating how metropolitan human milk banks contribute to the growth outcomes of very preterm infants cared in rural areas. The setting of this study is located at a rural county in Taiwan and affiliated with the Taiwan Southern Human Milk Bank. Donor human milk was provided through a novel supplemental system. A renewal nutritional protocol was initiated as a quality improvement project after the affiliated program. This study aimed to compare the clinical morbidities and growth outcome at term equivalent age (TEA) of preterm infants less than 33 weeks of gestational age before (Epoch-I, July 2015–June 2018, n = 40) and after the new implementation (Epoch-II, July 2018–December 2020, n = 42). The Epoch-II group significantly increased in bodyweight z-score at TEA ((−0.02 ± 1.00) versus Epoch-I group (−0.84 ± 1.08), p = 0.002). In multivariate regression models, the statistical difference between two epochs in bodyweight z-score changes from birth to TEA was still noted. Modern human milk banks may facilitate the nutritional protocol renewal in rural areas and improve the growth outcomes of very preterm infants cared for. Establishing more distribution sites of milk banks should be encouraged.

scholarly journals Prevalence and Risk Factors for Adrenal Insufficiency in Patients with Multiple Myeloma Receiving Long-Term Chemotherapy including Corticosteroids: A Retrospective Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Jee Hee Yoon ◽  
Seo-Yeon Ahn ◽  
Sung-Hoon Jung ◽  
Je-Jung Lee ◽  
Wonsuk Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Adrenal Insufficiency ◽  
Cumulative Dose ◽  
Univariate Analysis ◽  
Megestrol Acetate ◽  
High Dose ◽  
Acth Stimulation ◽  
Increased Risk

Multiple myeloma (MM) is the second most common hematologic malignancy and requires long-term and high-dose corticosteroid-based chemotherapy. The aim of this study was to investigate the prevalence and clinical predictors of corticosteroid-associated adrenal insufficiency (AI) in patients with MM receiving long-term chemotherapy. This retrospective study included patients with MM who were administered corticosteroid-based chemotherapy and underwent a rapid adrenocorticotropic hormone (ACTH) stimulation test between 2005 and 2018. AI was determined by a peak cortisol value < 18  μg/dL after ACTH stimulation. Demographic, clinical, and laboratory parameters were evaluated, and the prevalence and clinical risk factors of AI were examined. Of 282 patients with MM who received corticosteroid-based chemotherapy, 142 patients (50.4%) were classified as having AI. There were no differences in age, sex, body mass index, comorbidities, and laboratory findings, including serum sodium levels between the AI and no-AI groups. In univariate analysis, the cumulative dose of corticosteroid ( odds   ratio   OR = 0.99 , 95% confidence interval (CI) 0.98–0.99; P = 0.020 ) and megestrol acetate use ( OR = 2.63 , 95% CI 1.48–4.67; P = 0.001 ) were associated with the occurrence of AI. Cumulative duration and cumulative dose per duration of corticosteroid use were not associated with the occurrence of AI. However, in the multivariate analysis, only megestrol acetate use was associated with an increased risk of AI ( OR = 2.54 , 95% CI 1.41–4.60; P = 0.002 ). Approximately 95.8% of patients with AI had suspicious symptoms or signs of AI. Although clinical symptoms and signs are usually nonspecific, symptomatic patients with MM receiving long-term corticosteroid therapy have sufficient potential for developing AI, particularly when receiving megestrol acetate. These findings can help alert clinicians to consider adrenal suppression following corticosteroid-based chemotherapy in patients with MM.

Long-term survival of adjuvant high-dose (HDC) vs weekly cisplatin (WC) for human papilloma-virus (HPV) and non-HPV head and neck squamous cell carcinoma (HNSCC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6071-6071 ◽  
Author(s):  
Katharine Andress Rowe Price ◽  
Ashish V. Chintakuntlawar ◽  
Robert Leonard Foote ◽  
Yolanda I. Garces ◽  
Daniel Ma ◽  
...  
Keyword(s):  
Cumulative Dose ◽  
Multivariate Analyses ◽  
Surrogate Marker ◽  
Phase Iii ◽  
High Dose ◽  
Term Survival ◽  
Long Term Survival ◽  
Risk Of Death ◽  
Hpv Status

6071 Background: Phase III data suggests a benefit of HDC in the adjuvant setting, but the effect of HDC and WC on long term survival and for HPV+ HNSCC is unknown. Methods: Data from a published retrospective study (Geiger Oral Onc 2013) of HDC vs WC in resected HNSCC was updated. Overall survival (OS) and recurrence-free survival (RFS) was assessed by Kaplan-Meier method for all pts and by HPV status. Multivariate analyses were performed to assess impact of HPV status, smoking, age, HDC vs WC, and cumulative cisplatin dose ( < 200mg/m2 vs ≥200 mg/m2). Results: 51 patients (pts) received HDC and 53 WC. Median follow-up was 8.7 yrs (0.8-13.7). For the whole cohort, HDC had significantly improved OS over WC (p = 0.0095; 5- and 10-yr OS 84% and 80% vs 72% and 60%). No OS benefit for HDC was seen in pts with HPV+HNSCC (5- and 10-yr OS 90% and 87% for HDC and 81% and 81% for WC; p = 0.51). For HPV-negative HNSCC, OS had borderline significance with HDC vs WC (5- and 10-yr OS 73% and 68% vs 65% and 44%; p = 0.06). For the whole cohort, there was no difference in 5- and 10-yr RFS (78% and 74% for HDC vs 72% and 62% for WC; p = 0.32). When analyzed by HPV status, there was no difference in RFS with HDC or WC for either HPV+ (p = 0.43) or HPV-negative HNSCC (p = 0.97). On multivariate analyses of OS for all pts, only HPV status was significant (p = 0.0011; HR 0.27, CI 0.12-0.62). For HPV+ HNSCC, there was no significant predictor of OS. For non-HPV HNSCC, the benefit of HDC approached significance with a decreased risk of death (HR 0.38; p = 0.07). For all pts, those who received ≥200mg/m2 had significantly improved OS (5-yr 90% vs 72% and 10-yr 86% vs 61%; p = 0.004). By HPV status, cumulative dose had no significant effect on OS. Conclusions: OS is better with HDC and with cumulative dose > 200 mg/m2 in unselected patients. The benefit of cisplatin is likely higher for non-HPV HNSCC. A difference in OS with no difference in RFS suggests non cancer-related causes of death in the WC cohort. Ability to receive HDC could be a surrogate marker of comorbidity. [Table: see text]

scholarly journals Corticosteroids for the prevention of bronchopulmonary dysplasia in preterm infants: a network meta-analysis

2018 ◽  
Vol 103 (6) ◽  
pp. F506-F511 ◽  
Author(s):  
Linan Zeng ◽  
Jinhui Tian ◽  
Fujian Song ◽  
Wenrui Li ◽  
Lucan Jiang ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Low Birthweight ◽  
Low Dose ◽  
Meta Analysis ◽  
Cochrane Library ◽  
High Dose ◽  
Extremely Preterm ◽  
Subgroup Analyses

ObjectiveTo determine the comparative efficacy and safety of corticosteroids in the prevention of bronchopulmonary dysplasia (BPD) in preterm infants.Study designWe systematically searched PubMed, EMBASE and the Cochrane Library. Two reviewers independently selected randomised controlled trials (RCTs) of postnatal corticosteroids in preterm infants. A Bayesian network meta-analysis and subgroup analyses were performed.ResultsWe included 47 RCTs with 6747 participants. The use of dexamethasone at either high dose or low dose decreased the risk of BPD (OR 0.29, 95% credible interval (CrI) 0.14 to 0.52; OR 0.58, 95% CrI 0.39 to 0.76, respectively). High-dose dexamethasone was more effective than hydrocortisone, beclomethasone and low-dose dexamethasone. Early and long-term dexamethasone at either high dose or low dose decreased the risk of BPD (OR 0.11, 95% CrI 0.02 to 0.4; OR 0.37, 95% CrI 0.16 to 0.67, respectively). There were no statistically significant differences in the risk of cerebral palsy (CP) between different corticosteroids. However, high-dose and long-term dexamethasone ranked lower than placebo and other regimens in terms of CP. Subgroup analyses indicated budesonide was associated with a decreased risk of BPD in extremely preterm and extremely low birthweight infants (OR 0.60, 95% CrI 0.36 to 0.93).ConclusionsDexamethasone can reduce the risk of BPD in preterm infants. Of the different dexamethasone regimens, aggressive initiation seems beneficial, while a combination of high-dose and long-term use should be avoided because of the possible adverse neurodevelopmental outcome. Dexamethasone and inhaled corticosteroids need to be further evaluated in large-scale RCTs with long-term follow-ups.

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