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Helen Harrison writes:

Here is an important study abstract that shows the importance of "longterm" follow-up, in this case by school age, of children exposed to post-natal steroids. Note, these are not children who were necessarily considered "impaired" in early childhood:

Outcomes at School Age after Postnatal Dexamethasone Therapy for Lung Disease of Prematurity

New England Journal of Medicine,
350;1304- 25,2004.

Tsu F. Yeh, ., Yuh J. Lin, ., Hung C. Lin, ., Chao C. Huang, ., Wu S. Hsieh, ., Chyi H. Lin, ., and Cheng H. Tsai, .

ABSTRACT

Background: We studied the outcomes at school age in children who had participated in a double-blind, placebo-controlled trial of early postnatal dexamethasone therapy (initiated within 12 hours after birth) for the prevention of chronic lung disease of prematurity.

Methods: Of the 262 children included in the initial study, 159 lived to school age. Of these children, 146 (72 in the dexamethasone group and 74 in the control group) were included in our study. All the infants had had severe respiratory distress syndrome requiring mechanical ventilation shortly after birth. In the dexamethasone group, mg of dexamethasone per kilogram of body weight was given intravenously every 12 hours for one week, and then the dose was tapered. We evaluated the children's growth, neurologic and motor function, cognition, and school performance.

Results: Children in the dexamethasone group were significantly shorter than the controls (P= for boys, P= for girls, and P= for all children) and had a significantly smaller head circumference (P=). Children in the dexamethasone group had significantly poorer motor skills (P<), motor coordination (P<), and visual–motor integration (P=). As compared with the controls, children in the dexamethasone group also had significantly lower full IQ scores (mean [±SD], ± vs. ±; P=), verbal IQ scores (± vs. ±, P=), and performance IQ scores (± vs. ±, P=). The frequency of clinically significant disabilities was higher among children in the dexamethasone group than among controls (28 of 72 [39 percent] vs. 16 of 74 [22 percent], P=).

Conclusions: Early postnatal dexamethasone therapy should not be recommended for the routine prevention or treatment of chronic lung disease, because it leads to substantial adverse effects on neuromotor and cognitive function at school age.

In a group of close to 26,000 infants, about a quarter suffered from some type of IVH, and 7 percent had severe brain bleeding. However, results from the analysis revealed that the risk of all types of intraventricular hemorrhages was one-third lower in babies whose mothers received prenatal steroids, when compared to mothers who didn't receive any steroids. In addition, the risk for the most severe forms of IVH were halved, a result most significant in babies born between 22 and 29 weeks of pregnancy — an age group once thought to be too young to benefit from the treatment.

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