ABSTRACT
BACKGROUND: Excess of iron and oxidant injury shortly after birth may be associated with neonatal morbidities in preterm infants. AIMS: The aim was to determine whether administration of erythropoietin without iron supplementation decreases iron load and morbidity. STUDY DESIGN AND SUBJECTS: In a randomized trial, we administered erythropoietin (EPO 250IU/kg daily during the first 6days of life) or placebo to 39 preterm infants (BW 700-1500g, GA≤30.0weeks). OUTCOME MEASURES: The iron status, postnatal morbidities and follow-up at the age of two years were investigated. RESULTS: In all, 21 EPO- and 18 placebo-treated infants were recruited. A requirement of red blood cell transfusions during first 28days was similar between the study groups. EPO treatment decreased total serum iron concentration (p=0.035). EPO supplementation had no significant effect on serum transferrin receptors or reactive non-protein-bound iron. There were no differences in neonatal morbidity or in survival without major neurological abnormality at two years of age. CONCLUSIONS: A 6-day course of EPO decreased the iron load in preterm infants. There was no change in reactive, non-protein bound iron plasma levels and no influence on the outcomes during early childhood. Whether the neurocognitive effects of early EPO treatment can be detectable later in childhood remained to be verified.
Subject(s)
Erythropoietin/therapeutic use , Infant, Premature/blood , Iron Overload/drug therapy , Iron/blood , Erythropoietin/administration & dosage , Erythropoietin/adverse effects , Female , Humans , Infant , Infant, Newborn , Infant, Premature/growth & development , Iron Overload/prevention & control , MaleABSTRACT
BACKGROUND: Weekly repeated antenatal corticosteroid treatment improves respiratory outcome but decreases fetal growth and may impair neurodevelopmental outcome. We have previously reported that a single repeat betamethasone (BM) dose neither decreased fetal growth nor improved the outcome of preterm infants during the first hospitalisation. OBJECTIVE: To study prospectively whether a single repeat dose of BM influences neurodevelopment and growth within 2 years. DESIGN: Women with imminent delivery before 34.0 gestational weeks were eligible if they remained undelivered for >7 days after a single course of antenatal BM. After stratification, a single repeat dose of BM (12 mg) or placebo was given. The children underwent neurological and psychometric examinations and a speech evaluation at a corrected age of 2 years. SETTING: Prospective, blinded evaluation following the randomised multicentre trial. PATIENTS: 259 (82%) surviving infants completed the 2-year follow-up, 120 in the BM group and 139 in the placebo group. RESULTS: The rate of survival without severe neurodevelopmental impairment was similar in both groups (BM 98%, placebo 99%). The risk of cerebral palsy (BM 2%, placebo 1%), growth or re-hospitalisation rates (BM 60%, placebo 50%) did not differ between the groups. CONCLUSIONS: A single repeat dose of antenatal BM tended not to influence physical growth or neurodevelopment at 2 years of age.
Subject(s)
Betamethasone/administration & dosage , Child Development/drug effects , Developmental Disabilities/chemically induced , Glucocorticoids/administration & dosage , Infant, Premature, Diseases/prevention & control , Adult , Betamethasone/adverse effects , Child, Preschool , Drug Administration Schedule , Female , Follow-Up Studies , Glucocorticoids/adverse effects , Humans , Infant , Infant, Newborn , Infant, Premature , Male , Pregnancy , Pregnancy Trimester, Third , Premature Birth/drug therapy , Prenatal Care/methods , Prospective Studies , Young AdultABSTRACT
AIM: To determine the impact of antenatal glucocorticoid on neonatal glucose homeostasis. METHODS: This is a retrospective gestationally paired survey followed by a randomized study. On the basis of the interval between last antenatal dexamethasone and birth, 228 preterm infants born before 34 weeks were divided into Short (< 24 h), Intermediate (1-6 days), and Long (> or = 7 days) exposure groups and compared their gestationally paired controls. After a single course of betamethasone, the parturients remaining undelivered for one week were randomized to receive either one dose of betamethasone (n = 52) or placebo (n = 53). Glucose values were recorded at 11 time points in the first 3 days of life. Hypoglycaemic and hyperglycaemic values were counted. RESULTS: There were no overall differences in mean glucose levels between the antenatal glucocorticoid and the control groups. However, the long exposure time to antenatal glucocorticoid was associated with increased risk of hyperglycaemia (OR 4.1; 2.2-7.6). CONCLUSION: Antenatal glucocorticoid administration was associated with subtle disturbances of glucose homeostasis in preterm infants. These differences were dependent on the length of drug-delivery interval so that long exposition time seemed to increase the incidence of hyperglycaemia during the first days of life.
