Study: Preemie treatment can damage brains

[Guest guest]

Steroid shown to cause mental problems, slow growth

Wednesday, March 24, 2004 Posted: 5:00 PM EST

(AP) -- A common steroid treatment for premature babies with lung

problems can damage their brains and slow their growth, the first

long-term study of the practice found.

The bodies of many premature babies do not yet make a chemical that

keeps the lungs from collapsing when the infants exhale. Respirators

keep them breathing but can stretch the fragile lungs. This causes

inflammation and other damage, contributing to chronic lung disease.

To prevent chronic lung disease, doctors often give these babies the

steroid dexamethasone to reduce inflammation.

To check its long-term safety, doctors at six hospitals in Taiwan

looked at 146 school-age children who had been born prematurely and

put on breathing machines. The children had been given dexamethasone

or dummy shots for four weeks as infants.

As babies, 15 percent of those given dexamethasone developed chronic

lung disease, compared with 28 percent of those who got placebos.

But eight years later, the children who had been on the steroid were

shorter than the others by about an inch and a half, they were less

coordinated, and they had lower IQ scores, Dr. Tsu-Fuh Yeh of China

Medical University in Taiwan reported in Thursday's New England

Journal of Medicine.

" Dexamethasone is widely used. Some doctors use dexamethasone like

water. Not only in North America -- in Europe, in Asia, " he said.

Yeh said the long-term risks clearly outweigh the benefits. Although

many people had known there might be long-term effects, he

said, " because nobody's proved it, they still use it. Our paper is

quite conclusive. "

Caution urged

All premature babies are at risk for brain damage. But the 72

children who had been given dexamethasone had IQs an average of five

points lower than the 74 who had received the dummy shots. They were

also more easily distracted and scored an average of three points

lower on a 36-point arithmetic test.

Those differences did not affect the youngsters' schoolwork. That is

probably because many Taiwanese families with disabled children hire

tutors or send them to special classes to help them catch up, Yeh

said.

It is not clear exactly how widely dexamethasone is used. Over the

past few years, three major pediatric associations in the United

States, Canada and Europe -- including the American Academy of

Pediatrics -- have recommended against using the steroid in premature

babies, because of side effects that include holes in the stomach or

intestine. Other types of steroids are available.

The bottom line is that very few of the drugs used in preterm infants

have ever been tested for use in preterm infants.

-- Dr. Alan Jobe

Dr. Alan Jobe of Cincinnati Children's Hospital Medical Center said

the findings indicate that doctors need to be very cautious with any

steroids given to premature babies, and that more tests are needed to

find the safest way to give them.

Nearly one-third of the smallest babies who make it out of the

hospital suffer from chronic lung disease. They are more prone to

lung infections. Some need months on breathing machines or extra

oxygen.

Jobe and Dr. Auten of Duke University said doctors today are

most likely to use steroids as a last resort and to use much less

than the Taiwanese babies got. In very tiny babies, he said, doctors

are more likely to use lower doses of a less potent steroid called

hydrocortison.

Two U.S. surveys in 2002 found that about one-fifth of all babies

with respiratory distress syndrome got some sort of steroid at some

point in their treatment, Jobe said. The surveys did not ask which

steroid was used, or how much of it and for how long.

Steroids have been proven to help these babies who are developing

chronic lung disease -- but tests are needed to find the lowest

possible doses, and to see how these children do in the long term,

Jobe said.

" The bottom line is that very few of the drugs used in preterm

infants have ever been tested for use in preterm infants, " he said.

http://www.cnn.com/2004/HEALTH/parenting/03/24/preemie.lungs.ap/index.

html