Qualitative assessment of general movements in high-risk preterm infants with chronic lung disease requiring dexamethasone therapy

• Published in: The Journal of pediatrics Vol. 132; no. 2; pp. 300 - 306
• Main Authors: Bos, Arend F., Martijn, Albert, van Asperen, Roelie M., Hadders-Algra, Mijna, Okken, Albert, Prechtl, Heinz F.R.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.1998; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Chronic Disease; Dexamethasone - therapeutic use; Echoencephalography; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Female; Glucocorticoids - therapeutic use; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - diagnostic imaging; Infant, Premature, Diseases - drug therapy; Infant, Premature, Diseases - physiopathology; Intensive care medicine; Lung Diseases - diagnostic imaging; Lung Diseases - drug therapy; Lung Diseases - physiopathology; Male; Medical sciences; Motor Activity; Human; Premature; Lung disease; Corticosteroid; Nervous system diseases; Dexamethasone; Pregnancy disorders; Respiratory disease; Toxicity; Infant; Cerebral disorder; Very low birthweight; Newborn diseases; Chemotherapy; Association; Newborn; Treatment; Central nervous system disease; Body movement; Bronchus disease; Bronchopulmonary dysplasia; Biological effect; Motricity
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(98)70449-4

Objective: The objective of this study was to determine in preterm infants at risk for severe chronic lung disease (1) the quality of general movements (GMs) and (2) the effect of dexamethasone treatment on spontaneous motor activity. Study design: In 15 very low birth weight infants the quality of GMs was assessed from repeated videotape recordings. Recordings were made at weekly intervals during the preterm period until term age and thereafter three times until the twentieth postterm week. All infants required dexamethasone therapy, and additional recordings were made a few hours before and 24 hours, 48 hours, and 7 days after dexamethasone was started. The relationship among movement quality, brain ultrasonographic abnormalities, and long-term outcome was explored. Acute effects of dexamethasone on motor activity were examined. Results: After dexamethasone therapy was started, a significant transient reduction of the quantity of most spontaneous movements ( p < 0.05) and a reduction of speed and amplitude of GMs was found ( p < 0.05). A significant relationship was found between the severity of brain ultrasonographic abnormalities and the extent to which developmental trajectories of GMs were abnormal ( p < 0.001). The development of cerebral palsy was related to the presence of cramped-synchronized movements near term ( p < 0.02) and to the absence of fidgety movements at the age of 3 months after term ( p < 0.05). Conclusion: In preterm infants with severe chronic lung disease and brain lesions, dexamethasone treatment leads to an acute reduction in motility and changes in the speed and amplitude of GMs. Until more is known about long-term neurologic sequelae, a cautious use of systemic dexamethasone therapy in preterm infants is recommended. (J Pediatr 1998;132:300-6)