PEDIATRICS Vol. 98 No. 2 August 1996, pp. 204-210
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A Controlled Trial of Dexamethasone to Prevent Bronchopulmonary Dysplasia in Surfactant-treated Infants

Alok Rastogi MD, MRCP1, Subuola M. Akintorin MD2, Michelle L. Bez DO3, Pablo Morales MD4, and Rosita S. Pildes MD5

1 Department of Pediatrics, University of Illinois, Chicago; Division of Neonatology, Cook County Children's Hospital, Chicago
2 Division of Neonatology, Cook County Children's Hospital, Chicago
3 Division of Neonatology, Cook County Children's Hospital, Chicago; Division of Neonatology, Our Lady of Lourdes Medical Center, Camden, New Jersey
4 Division of Neonatology, Cook County Children's Hospital, Chicago; Division of Neonatology, Rockford Memorial Hospital, Rockford, Illinois
5 Division of Neonatology, Cook County Children's Hospital, Chicago; Department of Pediatrics, Finch University of Health Sciences, Chicago

Background. Surfactant therapy now has a well-established role in the treatment of neonates with respiratory distress syndrome but has failed to reduce the incidence of bronchopulmonary dysplasia (BPD). We conducted a double-blind, placebo-controlled trial to test the hypothesis that dexamethasone therapy given during the first 12 days of life to very low birth weight infants would be synergistic to surfactant in preventing BPD.

Methods. Seventy surfactant-pretreated infants (700-1500 g) who had severe respiratory distress syndrome (a/A ratio, 0.18 ± 0.10; mean airway pressure, 11.1 ± 1.9 cm H2O; fraction of inspired oxygen, 0.81 ± 0.22) were enrolled to receive a 12-day course of dexamethasone (n = 36) or saline placebo (n = 34) starting within the first 12 hours after birth. The starting dose of dexamethasone was 0.5 mg/kg per day, and it was tapered progressively.

Results. Ventilator variables at 5 to 14 days were significantly improved in those infants who received dexamethasone compared with those who received the placebo. The effect seem to be more marked in infants weighing less than 1250 g at birth. Significantly more infants could be extubated by 14 days of age in the dexamethasone group (26 of 32 vs 14 of 32). Dexamethasone therapy reduced the incidence of BPD at 28 days (odds ratio, 0.1; 95% confidence interval, 0.03 to 0.3) and eliminated BPD at 36 weeks' postconceptional age. Dexamethasone-treated infants had greater weight loss at 14 days (12.9 ± 6.4% vs 3.7 ± 8.6%, respectively) and higher blood pressures from days 3 to 10. However, no differences were seen in time to regain birth weight, hypertension (1 infant in each group), or incidence of intraventricular hemorrhage.

Conclusions. We found an additive effect between dexamethasone and surfactant in improving pulmonary status and reducing the incidence of BPD. Compared with the placebo, dexamethasone therapy was more effective in reducing the incidence of BPD in surfactantpretreated very low birth weight infants.

Submitted on July 26, 1995
Accepted on September 15, 1995




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