PEDIATRICS Vol. 117 No. 1 January 2006, pp. 75-83 (doi:10.1542/peds.2004-2843)
ARTICLE |
Low-Dose Dexamethasone Facilitates Extubation Among Chronically Ventilator-Dependent Infants: A Multicenter, International, Randomized, Controlled Trial
a Obstetrics and Gynaecology
b Paediatrics, University of Melbourne, Melbourne, Australia
c Division of Newborn Services, Royal Women's Hospital, Melbourne, Australia
d Department of Neonatology, Women's and Children's Hospital, Adelaide, Australia
e Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
OBJECTIVE. Postnatal corticosteroid therapy is controversial. The aim of this study was to determine the short-term effects of low-dose dexamethasone treatment among chronically ventilator-dependent neonates.
METHODS. Very preterm (gestational age: <28 weeks) or extremely low birth weight (birth weight: <1000 g) infants who were ventilator dependent after the first 1 week of life were eligible and were assigned randomly to receive masked dexamethasone (0.89 mg/kg over 10 days) or saline placebo. Data on ventilator and oxygen requirements and deaths were recorded.
RESULTS. Seventy infants were recruited from 11 centers, at a median age of 23 days. More infants were extubated successfully by 10 days of treatment in the dexamethasone group (60%, 21 of 35 patients) than in the control group (12%, 4 of 34 patients) (odds ratio [OR]: 11.2; 95% confidence interval [CI]: 3.2–39.0). Ventilator and oxygen requirements improved substantially, and the duration of intubation was shorter. There was little evidence for a reduction in either the mortality rate (dexamethasone group: 11%; control group: 20%; OR: 0.52; 95% CI: 0.14–1.95) or the rate of oxygen dependence at 36 weeks (dexamethasone group: 85%; control group: 91%; OR: 0.58; 95% CI: 0.13–2.66). There were no obvious effects of low-dose dexamethasone on blood glucose concentrations, blood pressure, or other complications. No infant experienced intestinal perforation.
CONCLUSIONS. Low-dose dexamethasone treatment after the first 1 week of life clearly facilitates extubation and shortens the duration of intubation among ventilator-dependent, very preterm/extremely low birth weight infants, without any obvious short-term complications. Combined with recent evidence that infants at very high risk of bronchopulmonary dysplasia may benefit in the long term, our study reopens debate regarding the role of low-dose, late postnatal, corticosteroid therapy.
Key Words: infant • preterm • low birth weight • low-dose dexamethasone • extubation • bronchopulmonary dysplasia
Abbreviations: OR—odds ratio • CI—confidence interval • ELBW—extremely low birth weight • DART—Dexamethasone: A Randomized Trial • IQR—interquartile range • FIO2—inspired oxygen concentration • BPD—bronchopulmonary dysplasia • RCT—randomized, controlled trial
Accepted Mar 30, 2005.
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