Presented at the Neonatal Society 2003 Spring Meeting.
Kapellou O1, Ajaye-Obe M1, Kennea N1, Counsell S2, Allsop J2, Saeed N2, Duggan P1, Maalouf E1, Laroche S1, Cowan F1, Rutherford M2, Edwards AD1
1 Department of Paediatrics and Neonatal Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
2 Robert Steiner MR Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Hammersmith Campus, London, UK
Background: Corticosteroid therapy has been suggested to have a deleterious effect on neurodevelopment.
Aim: To determine by quantitative analysis of magnetic resonance (MR) images whether administration of corticosteroids to infants with bronchopulmonary dysplasia (BPD) reduces the growth of brain cortical surface area (CSA) and complexity (CC), and the cerebral volume (CV) in a dose dependent manner and in excess of any effect on somatic growth.
Patients and Methods: 121 MR brain images were examined, obtained at between 24 and 42 weeks gestational age in 36 preterm infants of gestational age median 27 (range 23-30) weeks, and birthweight 903 (503-1600) g. No MR image showed haemorrhagic parenchymal infarction or periventricular leucomalacia. 35 (97%) of mothers had received betamethasone (12-72 mg) before delivery, and 18 (50%) of infants received postnatal dexamethasone (0.5-18.3 mg.kg-1). CSA, CC, and CV were measured using interactive post-processing. Data distributions were transformed to normality before analysis of variance controlling for postnatal age and weight. Significance was accepted at the 5% level.
Results: Postnatal but not antenatal steroid administration was associated with a dose-related reduction in the rate of brain development in excess of any effect on body weight. Reduction (95% CI) in brain development associated with dexamethasone was: CSA 2.2 (0.4-4.0), CV 2.0 (0.6-3.4) and CC 1.5 (0.02-2.9) %.mg-1. Steroid treatment co-varied with duration of ventilation and total parenteral nutrition.
Conclusion: Chronic respiratory disease treated with dexamethasone is associated with dose-related reduction in brain development, which is additional to any effect on bodyweight.