Single-dose dexamethasone treatment of hypotension in preterm infants.
OBJECTIVE
To test the efficacy of single-dose dexamethasone (DXM) in the management of severe arterial hypotension of newborn infants. Our hypothesis was that epinephrine infusions could be discontinued in 70% of patients within 12 hours after DXM administration compared with 10% in the placebo group.


METHODS
Twenty preterm infants (median birth weight 690 g, gestational age 28 weeks, age at intervention 2 days) who did not respond to a standardized treatment protocol (blood/colloid followed by dopamine infusion stepwise increased to 15 micrograms/kg and minute) were started on an epinephrine infusion and were randomly allocated to receive either DXM (0.25 mg/kg) or placebo intravenously. The primary outcome criterion was the need for an epinephrine infusion 12 hours after treatment.


RESULTS
Three infants were excluded. Epinephrine infusion was discontinued in 5 of 8 infants with DXM but in only 1 of 9 infants in the control group. The duration of epinephrine infusion was significantly shorter in the DXM group (exact log-rank test, P =. 023).


CONCLUSIONS
DXM was effective for the management of severe arterial hypotension in preterm infants not responding to standardized treatment.
Gaissmaier
R E
RE
Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, University of Ulm, Ulm, Germany.
Pohlandt
F
F
D000322:Adrenergic Agonists / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology; D007231:Infant, Newborn; D007234:Infant, Premature; D011446:Prospective Studies; D013997:Time Factors
D000322:Adrenergic Agonists; D003907:Dexamethasone; D004837:Epinephrine