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TABLE 2

Neurodevelopmental Follow-up of Dexamethasone RCTs Reported After 2001

Study, Planned Age at Follow-upFollow-up, % (No. of Infants Seen)Treatment Start TimeDexamethasone Dosing RegimenPrimary Neurodevelopmental Findings
McEvoy et al,17  1 y 66 (39) At 7–21 d High vs low dose: 7-d taper from 0.5 mg/kg per d vs 0.2 mg/kg per d MDI < 70: 24% (high) vs 17% (low) (NS); CP: 10% vs 11%(NS) 
Armstrong et al,24  18 mo chronological age 96 (64) On day 7 42-d taper vs 3-d pulse No difference in 18-mo outcomes 
    No disability: 34% vs 31%(NS) 
Doyle et al,25  2 y corrected age 98 (58) After 7 d 0.15 mg/kg per d tapered over 10 d Death or major disability: 46% vs 43% (NS); death or CP: 23% vs 37% (NS); CP: 14% vs 22% (NS); major disability 41% vs 31%(NS) 
Stark et al,26  18–22 mo corrected age 74 (123) On day 1 0.15 mg/kg per d tapered over 7 d MDI < 70: 51% vs 43% (NS); PDI < 70: 30% vs 35%(NS); abnormal neurologic exam: 25% each group 
Romagnoli et al,27  3 y 100 (30) On day 4 0.5 mg/kg per d tapered over 1 wk No differences in any parameter; CP: 9% vs 14%(NS) 
Wilson et al,28  7 y 84 (127) Before 3 d 4 groups: 0.5 mg/kg per d tapered over 12 d vs late(15 d) selective, vs inhaled early or late selective No difference in cognitive, behavioral, CP, or combined outcomes 
Yeh et al,29  school age (mean: 8 y) 92 (146) On day 1 0.5 mg/kg per d for 1 wk, then tapered for a total of 28 d Treated children were shorter(P = .03), had smaller head circumference (P = .04), lower IQ scores (P = .008), and more significant disabilities (CP, IQ < 5th percentile, vision or hearing impairment): 39% vs 22% (P = .04) 
O'Shea et al,30  4–11 y 89 (84) On day 15–25 0.5 mg/kg per d tapered over 42 d vs placebo Death or major NDIa: 47% vs 41% (NS); major NDI alone: 36% vs 14% (P = .01) 
Gross et al,31  15 y 100 (22) On day 14 0.5 mg/kg per d tapered over 42 d vs 18-d taper vs placebo Intact survival (IQ > 70, normal neurologic exam, regular classroom): 69% vs 25% (18-d course) vs 18% (placebo)(P < .05) 
Jones and the Collaborative Dexamethasone Trial Follow-up Group,32  13–17 y 95 (150) At 2–12 wk 0.5 mg/kg per d for 7 d No difference in moderate/severe disability (defined as IQ > 2 SDs < mean, CP, hearing or vision loss); CP: 24% vs 15%(relative risk: 1.58 [95% confidence interval: 0.81–3.07]) 
Study, Planned Age at Follow-upFollow-up, % (No. of Infants Seen)Treatment Start TimeDexamethasone Dosing RegimenPrimary Neurodevelopmental Findings
McEvoy et al,17  1 y 66 (39) At 7–21 d High vs low dose: 7-d taper from 0.5 mg/kg per d vs 0.2 mg/kg per d MDI < 70: 24% (high) vs 17% (low) (NS); CP: 10% vs 11%(NS) 
Armstrong et al,24  18 mo chronological age 96 (64) On day 7 42-d taper vs 3-d pulse No difference in 18-mo outcomes 
    No disability: 34% vs 31%(NS) 
Doyle et al,25  2 y corrected age 98 (58) After 7 d 0.15 mg/kg per d tapered over 10 d Death or major disability: 46% vs 43% (NS); death or CP: 23% vs 37% (NS); CP: 14% vs 22% (NS); major disability 41% vs 31%(NS) 
Stark et al,26  18–22 mo corrected age 74 (123) On day 1 0.15 mg/kg per d tapered over 7 d MDI < 70: 51% vs 43% (NS); PDI < 70: 30% vs 35%(NS); abnormal neurologic exam: 25% each group 
Romagnoli et al,27  3 y 100 (30) On day 4 0.5 mg/kg per d tapered over 1 wk No differences in any parameter; CP: 9% vs 14%(NS) 
Wilson et al,28  7 y 84 (127) Before 3 d 4 groups: 0.5 mg/kg per d tapered over 12 d vs late(15 d) selective, vs inhaled early or late selective No difference in cognitive, behavioral, CP, or combined outcomes 
Yeh et al,29  school age (mean: 8 y) 92 (146) On day 1 0.5 mg/kg per d for 1 wk, then tapered for a total of 28 d Treated children were shorter(P = .03), had smaller head circumference (P = .04), lower IQ scores (P = .008), and more significant disabilities (CP, IQ < 5th percentile, vision or hearing impairment): 39% vs 22% (P = .04) 
O'Shea et al,30  4–11 y 89 (84) On day 15–25 0.5 mg/kg per d tapered over 42 d vs placebo Death or major NDIa: 47% vs 41% (NS); major NDI alone: 36% vs 14% (P = .01) 
Gross et al,31  15 y 100 (22) On day 14 0.5 mg/kg per d tapered over 42 d vs 18-d taper vs placebo Intact survival (IQ > 70, normal neurologic exam, regular classroom): 69% vs 25% (18-d course) vs 18% (placebo)(P < .05) 
Jones and the Collaborative Dexamethasone Trial Follow-up Group,32  13–17 y 95 (150) At 2–12 wk 0.5 mg/kg per d for 7 d No difference in moderate/severe disability (defined as IQ > 2 SDs < mean, CP, hearing or vision loss); CP: 24% vs 15%(relative risk: 1.58 [95% confidence interval: 0.81–3.07]) 

MDI indicates Bayley Mental Developmental Index; NS, not significant. PDI, Bayley Psychomotor Development Index; NDI, neurodevelopmental impairment.

a

Major neurodevelopmental impairment included CP and/or an IQ score of <70.

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