Association between postnatal dexamethasone for treatment of bronchopulmonary dysplasia and brain volumes at adolescence in infants born very preterm

Research output: Contribution to journalArticle

Authors

  • Jeanie L.y. Cheong
  • Alice C. Burnett
  • Katherine J. Lee
  • Gehan Roberts
  • Deanne K. Thompson
  • Alan Connelly
  • Peter J. Anderson
  • Lex W. Doyle

Colleges, School and Institutes

Abstract

Objectives
To compare brain volumes in adolescents who were born extremely preterm (<28 weeks gestation) who had received postnatal dexamethasone, and to determine if there was a postnatal dexamethasone dose–response effect on brain volumes.

Study design
Geographical cohort study of extremely preterm adolescents born in 1991-1992 in Victoria, Australia. T1-weighted magnetic resonance imaging was performed at 18 years of age. Segmented and parcellated brain volumes were calculated using an automated segmentation method (FreeSurfer) and compared between groups, with and without adjustment for potential confounders. The relationships between total postnatal dexamethasone dose and brain volumes were explored using linear regression.

Results
Of the 148 extremely preterm participants, 55 (37%) had received postnatal dexamethasone, with a cumulative mean dose of 7.7 mg/kg. Compared with participants who did not receive postnatal dexamethasone, those who did had smaller total brain tissue volumes (mean difference −3.6%, 95% CI [−7.0%, −0.3%], P value = .04) and smaller white matter, thalami, and basal ganglia volumes (all P < .05). There was a trend of smaller total brain and white matter volumes with increasing dose of postnatal dexamethasone (regression coefficient −7.7 [95% CI −16.2, 0.8] and −3.2 [−6.6, 0.2], respectively).

Conclusions
Extremely preterm adolescents who received postnatal dexamethasone in the newborn period had smaller total brain tissue volumes than those who did not receive postnatal dexamethasone, particularly white matter, thalami, and basal ganglia. Vulnerability of brain tissues or structures associated with postnatal dexamethasone varies by structure and persists into adolescence.

Details

Original languageEnglish
Pages (from-to)737-743.e1
JournalThe Journal of pediatrics
Volume164
Issue number4
Early online date12 Dec 2013
Publication statusPublished - 1 Apr 2014

Keywords

  • BPD, Bronchopulmonary dysplasia, MRI, Magnetic resonance imaging, PCS, Postnatal corticosteroid