Published online September 1, 2006
PEDIATRICS
Vol. 118
No. 3
September 2006, pp.
1316-1317
(doi:10.1542/peds.2006-1454)
Physiological Doses of Corticosteroids for Premature Infants
Anne Pardou, MD
Danièle Vermeylen, MD
Yves Hennequin, MD
Hinde Khyari, MD
Neonatal Intensive Care Unit,
Hôpital Erasme,
1070 Brussels, Belgium
To the Editor.—
There is controversy about the use of corticosteroids. What is called a low dose of dexamethasone in the article by Doyle et al1 is still a high dose, even if it is a tapering dose (10 days of treatment, total of 0.89 mg/kg; this is a pharmacologic dose, 3.75 times a "physiologic" dose of dexamethasone, deduced from the physiologic dose of cortisol defined by Metzger et al2). A physiologic dose could be used at decreasing doses to wean infants who are chronically dependent on a ventilator or nasal continuous positive airway pressure (NCPAP). Very often, NCPAP-dependent infants show cardiorespiratory instability defined by the occurrence of a great number of desaturations, bradycardias, and apneas.
We used physiologic doses of dexamethasone without bisulfite preservative at decreasing doses: 0.04 mg/kg on day 1, 0.03 mg/kg on day 2, and 0.02 mg/kg on day 3 (total: 0.09 mg/kg over 3 days) after the first week of life. Different causes of cardiorespiratory instability such as anemia, patent ductus arteriosus, pulmonary infection, septicemia, and nasopharyngeal obstruction were excluded. We did so in 14 of 30 infants born in 2004–2005 with a gestational age <29 weeks (mean gestational age: 26.8 weeks; mean birth weight: 876.4 g). The dexamethasone was given at a mean age of 16.2 days (range: 7–30).
NCPAP could be stopped very quickly, usually within the 3 days of treatment, the radiographs cleared up, and the cardiorespiratory instability disappeared. In 2 infants born at 26 weeks of gestation, a second course of dexamethasone was necessary 18 and 20 days after the first course because the cardiorespiratory instability reappeared. None of the infants died or developed necrotizing enterocolitis, gastrointestinal hemorrhage, or perforation related to the corticosteroids. We observed no cardiac hypertrophy or hypertension, and only 1 infant had hyperglycemia (180 mg%/mL).
Of 14 preterm infants treated with dexamethasone, 8 developed nosocomial septicemia (Fig 1), but in only 5 of these 8 infants was a relationship with dexamethasone possible. Of the 16 preterm infants not treated with dexamethasone, 5 developed nosocomial septicemia. The rate of nosocomial infection for the 30 infants born before 29 weeks of gestation was 43%.
The use of physiologic decreasing doses of dexamethasone for a short period (3 days) allows a great reduction of apneas, bradycardias, and desaturations and the weaning off of NCPAP without complications.
REFERENCES
- Doyle LW, Davis PG, Morley CJ, McPhee A, Carlin JB; DART Study Investigators. Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: a multicenter, international, randomized, controlled trial.
Pediatrics. 2006; 117: 75–83[CrossRef][ISI][Medline]
- Metzger DL, Wright NM, Veldhuis JD, Rogol AD, Kerrigan JR. Characterization of pulsatile secretion and clearance of plasma cortisol in premature and term neonates using deconvolution analysis.
J Clin Endocrinol Metab. 1993;77
:458
–463[Abstract]
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics
