Functional outcome at school age of preterm-born children treated with low-dose dexamethasone

Verhage, S. (Suzanne) (2015) Functional outcome at school age of preterm-born children treated with low-dose dexamethasone. thesis, Medicine.

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Abstract

Background Postnatal dexamethasone (DXM) treatment is given to preterm children to prevent or treat bronchopulmonary dysplasia (BPD). It is known that preterm children treated with high-dose DXM have adverse motor, cognitive and behavioral outcome at school age. However, it is largely unknown whether the functional outcome at school age is affected when the children are treated with low-dose DXM. Aims The aim of this study was to assess the motor skills, cognition, and behavioral problems at school age, in a cohort of preterm born infants who were treated with low-dose DXM in the neonatal period. Our second aim was to compare the outcome measures with a preterm reference group, if available, derived from recently published meta-analyses. Study design In an observational cohort study, we included 23 preterm infants born <32 weeks of gestation who were treated with low-dose DXM (starting dose of 0.25 mg/kg/day) during their admission to the neonatal intensive care unit of University Medical Center Groningen between 2002 and 2008. Results Low-dose DXM treated children scored significantly poorer on motor skills as compared with a Dutch norm group (P<.001 for all subgroups) with 78%, 48%, 47%, and 58% of these children scoring abnormal (< fifth percentile (P5)) on total Movement-ABC, fine motor skills, ball skills, and balance, respectively. Two out of 23 included children had cerebral paresis, with a Gross Motor Function Classification Scale (GMFCS) of 4. Furthermore, 20% of the low-dose DXM treated children scored an intelligence quotient (IQ) of ≤76 (i.e. <P5, classified as abnormal), which was significantly more often as compared with a Dutch norm group (P=.002). Performance IQ (PIQ) was more often affected than verbal IQ (VIQ), as respectively 40% and 10% of the low dose DXM treated children scored abnormal. We also found significantly more children scoring abnormal (<P5) on verbal learning and verbal long-term memory as compared with the Dutch norm group (15% and 25%, P=0.04 and P<.001, respectively). Selective attention and attentional control were also impaired as compared with the Dutch norm group with 25% and 50% of the children scoring abnormal (<P5) (P<.001, P<.001, respectively). Visual perceptive ability and language skills were not impaired as compared with the Dutch norm group. Finally, there were significantly more behavioral problems in the group of low-dose DXM treated children as compared with a Dutch norm group (P=.022 and P =.001, respectively) with 9% of the included children scoring abnormal (>P98) on total behavioral problems using the Child Behavioral CheckList questionnaire and 30% of the children scoring abnormal (>P90) on the hyperactivity scale of the Strengths and Difficulties questionnaire. When comparing the low-dose DXM treated children with a preterm reference group, they scored poorer on all the subscales of the Movement ABC (P<.001), but not on total intelligence. Conclusion This study showed that children treated with low-dose DXM scored poorer on motor skills, IQ, memory, attention, and behavioral problems at school age as compared with a Dutch norm group. Motor skills were affected the most when considering all tested functional domains. When comparing our movement-ABC and WISC-III test scores with a preterm reference group, scores on total intelligence was no longer lower in low-dose DXM treated children, but those on Movement-ABC still were significantly poorer. At school age, low-dose DXM treatment during the neonatal period seems to have more negative functional effects on motor skills than on cognitive skills.

Item Type:	Thesis (Thesis)
Supervisor name:	Facultair begeleider: and Bos, prof. dr. A.F. and Uitgevoerd in het UMCG, afdeling Neonatologie
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:49
Last Modified:	25 Jun 2020 10:49
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1016

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