Objectives: Corticosteroids are used to prevent or treat lung disease of prematurity. While neurological side effects have been reported, detailed effects on cerebellar growth are unknown. This... Show moreObjectives: Corticosteroids are used to prevent or treat lung disease of prematurity. While neurological side effects have been reported, detailed effects on cerebellar growth are unknown. This study aimed to compare cerebellar growth in premature infants who received dexamethasone or hydrocortisone to premature infants who did not receive postnatal corticosteroids. Study Design: Retrospective case-control study in infants born at a gestational age of <29 weeks and admitted to two level 3 neonatal intensive care units. Exclusion criteria were severe congenital anomalies and cerebellar or severe supratentorial lesions. Infants were treated with dexamethasone (unit 1) or hydrocortisone (unit 2) for chronic lung disease. Controls (unit 1) did not receive postnatal corticosteroids. Sequential head circumference (HC) and ultrasound measurements of transcerebellar diameter (TCD), biparietal diameter (BPD), and corpus callosum-fastigium length (CCFL) were performed until 40 weeks' postmenstrual age (PMA). Growth was assessed using linear mixed models correcting for PMA at measurement, sex, HC z-score at birth, and a propensity score indicating illness severity. Group differences before treatment were assessed using linear regression. Results: 346 infants were included (68 dexamethasone, 37 hydrocortisone, 241 controls). Before starting corticosteroids, TCD, BPD, and HC measurements did not differ between patients and controls at a comparable PMA. After starting treatment, both types of corticosteroid had a negative association with TCD growth. BPD, CCFL, and HC growth were not negatively affected. Conclusion: Administration of dexamethasone and hydrocortisone are both associated with impaired cerebellar growth in premature infants without evident negative associations with cerebral growth. Show less
This thesis describes the results of the Leiden Follow-Up Project on Prematurity (LFUPP): a prospective study in three health regions in the Netherlands, which included all live born infants with... Show moreThis thesis describes the results of the Leiden Follow-Up Project on Prematurity (LFUPP): a prospective study in three health regions in the Netherlands, which included all live born infants with gestational age (GA) <32 weeks, born in 1996/1997. Mortality, neonatal morbidity and the neurological examination as well as mental and psychomotor development according to the BSID I are described until the corrected age of 2 years. Special attention is paid to the infants with GA <27 weeks and the ethics of maintaining these extremely preterm infants. Growth (length, weight and head circumference) until 2 years of age is compared with the Dutch reference group. The influence of preterm growth restraint is compared with the influence of intrauterine growth restriction. The development and respiratory status at 2 years of age in infants with bronchopulmonary dysplasia are described. Finally, a comparison was made between the outcome of 2 cohorts, POPS (1983) and LFUPP (1996/1997) at time of hospital discharge and at 2 years of age. Show less
