Premature Babies Risk Steroid Brain Damage
Used to Help Respiratory Distress, Steroids Harm Child Development
March 25, 2004 -- Desperately ill premature babies often get steroids to prevent lung disease and to help get them off mechanical ventilators. But they may pay a terrible cost.
That price may be reduced IQ, poor motor skills, and stunted growth, according to a report in the March 25 issue of The New England Journal of Medicine.
Tsu F. Yeh, MD, of the China Medical University in Taichung, China, and colleagues examined 146 kids at the age of 8 years. All of the children were born prematurely. Their average birth weight was about 3 pounds. And all of them would likely have died if they hadn't been put on mechanical ventilators shortly after birth.
Starting shortly after birth, half of the preemies received treatment with a potent steroid called dexamethasone; the other half got an inactive placebo. Those treated with the steroid did a bit better. They had significantly less chronic lung disease at 28 days after birth. However, the study found no difference in the death rates between the two groups.
Some of the kids treated with steroids began showing signs of delayed growth by the time they were 2 years old. And at the age of 8, Yeh's team now finds, they were more likely to have a lower IQ, poor motor skills, and smaller size.
"This therapeutic regimen should not be recommended because of its adverse effects," Yeh and colleagues conclude.
In an editorial accompanying the study, Alan H. Jobe, MD, of Cincinnati's Children's Hospital Medical Center, notes that many U.S. doctors still use the treatment in desperately ill premature babies. Most prefer to use the somewhat gentler steroids hydrocortisone or betamethasone.
Jobe notes that the American Academy of Pediatrics, the Canadian Paediatric Society, and other groups have issued "pleas to stop using postnatal corticosteroids." But doctors are still using them, he says, because they seem to work.
Since this is so, Jobe calls for clinical trials of steroids at the lowest possible doses for the shortest possible time.
"Since clinicians will not stop using corticosteroids, we need to understand how to use them safely, if that is possible," he writes.