Postnatal dexamethasone treatment for preterm infants at high risk for bronchopulmonary dysplasia is associated with improved regional brain volumes: a prospective cohort study.

Abstract

Objective: To evaluate the effect of low-dose postnatal dexamethasone therapy for bronchopulmonary dysplasia (BPD) prevention/treatment on MRI-derived regional brain volumes at term-equivalent age (TEA) and neurodevelopmental outcomes in a regional cohort of preterm infants.

Study design: We prospectively recruited 392 preterm infants (≤32 weeks gestational age (GA)), who underwent structural MRI (3T Philips Ingenia) at TEA. We automatically segmented T2-weighted MRI scans using the Developing Human Connectome Project pipeline to derive a priori selected, two primary outcomes of interest: volumes of the cerebellum and subcortical grey matter. We estimated propensity scores for subjects with a logistic regression model and used weighted linear regression to determine the independent effects of dexamethasone on primary and two secondary outcomes: cortical surface area at TEA and motor scores at 2 years corrected age.

Results: Of 392 infants, 41 were treated with low cumulative dose dexamethasone (total 0.89 mg/kg) initiated at 36 days (median) of age for evolving BPD: 21 males; mean (SD) GA was 25.5 (1.6) weeks; postmenstrual age at MRI was 43.7 (1.2) weeks; and 33 had severe BPD. In multivariable linear regression, dexamethasone was significantly correlated with larger cerebellar (difference=0.510; 95% CI: 0.079 to 0.941) and subcortical grey matter volume (difference=0.138; 95% CI: 0.014 to 0.263). Dexamethasone was also positively correlated with motor scores (difference=5.220; 95% CI: 0.845 to 9.594).

Conclusion: Low-dose dexamethasone therapy after the first postnatal week for evolving/established BPD did not result in adverse macrostructural effects and may have a protective effect on motor development in preterm infants.