The use of dexamethasone in full-term infants with severe respiratory failure and pulmonary barotrauma.
Eight full-term infants (mean gestation 39.9 weeks [range 37-42] and mean birthweight 3642 g [range 3060-4200]) with severe respiratory failure (median oxygenation index 28 [range 16-65] and median arterial/alveolar PO2 ratio (a/APO2) 0.094 [range 0.038-0.165]) and pulmonary barotrauma were treated with Dexamethasone, 0.5 mg/kg per day, from the median age of 5 days (range 3-22). Six of the eight (75%) infants survived. They were weaned from mechanical ventilation and extubated a median of 2.5 days after commencing treatment with Dexamethasone. Two infants died and one of them suffered recurrent pneumothoraces. There was a significant improvement in oxygenation in the seven infants who survived the 72 h period of observation. Their median oxygenation index was 24 when Dexamethasone was commenced compared with 8 after 12 h (P less than 0.05) and 10 after 36 h (P less than 0.025). Their a/APO2 ratio was 0.095 when Dexamethasone was commenced compared with 0.289 after 12 h (P less than 0.05) and 0.207 after 36 h (P less than 0.025). There was a significant increase in the infants' arterial mean blood pressure associated with Dexamethasone therapy and one infant developed Staphylococcus aureus septicaemia. In this uncontrolled study of eight full-term infants with severe respiratory failure and pulmonary barotrauma, the use of Dexamethasone was associated with significant improvement in oxygenation and rapid weaning from mechanical ventilation.
Barr
P
P
Department of Neonatology, Royal Alexandra Hospital for Children, Camperdown, New South Wales, Australia.
D001469:Barotrauma / Q000188:drug therapy*; D003907:Dexamethasone / Q000627:therapeutic use*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D007231:Infant, Newborn; D055370:Lung Injury; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000188:drug therapy* / Q000628:therapy; D015300:Ventilator Weaning
D003907:Dexamethasone