FOLLOW-UP OF LONG-TERM USE OF DEXAMETHASONE IN PREMATURE INFANTS SHOWS HEALTH BENEFITS AS TEENAGERS
Gross SJ, Anbar RD, Mettelman BB. Follow-up at 15 years of preterm infants from a controlled trial of moderately early dexamethasone for the prevention of chronic lung disease. Pediatrics, 2005;115:681-687.
The American Academy of Pediatrics has recommended that dexamethasone not be used as treatment for long-term chronic lung disease in premature infants. Their view is based on questions regarding the long-term consequences of the drug on the overall health of the infants as they age. This study followed up on children who were initially studied as premature infants who had been treated with dexamethasone to see whether they showed negative effects of the treatment at 15 years of age.
The original study of 36 preterm infants separated them into 3 groups: a research group who had received dexamethasone over a 42-day period, a second research group who were treated with dexamethasone over an 18-day period, and a control group. At that time, there was no difference between the infants in the groups. The research findings at that time showed that the infants who received dexamethasone over 42 days had better respiratory outcomes than either those in the 18-day therapy or control groups. The mortality rate in the original study was 13 infants, leaving a final sample of 23 infants.
That original study had also reinvestigated those same children at 15 months of age and had found that 78% of those infants in the 42-day group had normal neurological and developmental status as opposed to only 22% in the 18-day group and 40% in the control group at that age. Those findings were now being furthered tested by the follow-up at 15 years of age.
At this latest inquiry, it was found that 1 child had died at age 14 from leukemia. All of the 22 children and parents gave assent and consent to this follow-up study. Data were collected to update their medical histories, especially neurological, respiratory, and developmental health. The children were given the Wechsler Intelligence Scale for Children III to assess their IQ scores, and teachers rated the children on their school work and functioning as well as their behavior in school.
The findings showed that the children in all of the groups had similar heights, weights, and head circumferences. Also, the original 42-day treatment group did not have neurological health problems, whereas 2 of those in the 18-day group and 1 in the control group did so. Eight of the 22 children had vision impairments, although 21 had corrected vision to 20/40 at least in 1 eye. Although most of the children had histories of respiratory problems over the prior years, none of the children were on continuous oxygen therapy.
The average IQ scores in the 42-day treatment group were higher (85) than both the 18-day (69) and control (73) groups. All of the children were schooled in regular classrooms but more children from the 18-day groups had behavior problems in school than the other groups.
The researchers indicated that these data were not sufficient to state that the 42-day dexamethasone therapy schedule was ideal for premature infants. However, they stated that these follow-up data were enough to show that the reduced history of chronic lung disease due to the dexamethasone treatment had some effect on the neurological and cognitive abilities of children at older ages. They stressed that more long-term research needs to be done to determine whether dexamethasone had positive effects on children who had long-term respiratory needs at birth.
FECAL ANTIGEN TESTS CAN IDENTIFY PEDIATRIC CASES OF H. PYLORI
Sabbi T, DeAngelis P, Colistro F, Dall'Oglio L, di Abriola GF, Castro M. Efficacy of noninvasive tests in the diagnosis of Helicobacter pylori infection in pediatric patients. Archives of Pediatrics and Adolescent Medicine, 2005;159:238-241.
Children have been found to be infected with Helicobacter pylori, which is implicated in various gastrointestinal diseases. The usual practice of endoscopy with mucosal biopsy for diagnosis is sometimes a controversial practice in children. Therefore, this research investigated whether the noninvasive fecal antigen test was as effective in identifying cases of H. pylori as the endoscopy.
The sample consisted of 250 children seen in a children's hospital in Rome, Italy for treatment of abdominal pain. All of the children had endoscopies and biopsies performed. These results were then compared to the results of the fecal antigen studies.
The results showed that the fecal antigen test was as effective as the endoscopy examination in identifying H.pylori infection (98% sensitivity). The researchers stated that this comparable effectiveness of the noninvasive test would be very helpful for diagnosis in children.