Early (4-7 days of age) dexamethasone therapy for prevention of chronic lung disease in preterm infants.
We conducted a comparative study to evaluate whether early (4-7 days of age) low-dose dexamethasone (DEX) therapy in preterm infants with surfactant-pretreated respiratory distress syndrome (RDS) would facilitate extubation and improve the clinical outcome. Twenty-six preterm infants with surfactant-pretreated RDS who were oxygen- and ventilator-dependent at 4 days of postnatal age were enrolled. Twelve infants were in the historical comparison group, and 14 infants were assigned to receive DEX 0.125 mg/kg i.v., every 12 h, for a total of 6 doses. At study entry, the two groups had a comparable clinical status. DEX therapy significantly facilitated weaning from mechanical ventilation (median interval, 6 vs. 24 days, p < 0.005) and shortened duration of oxygen supplementation (9 vs. 28 days, p < 0.05) as compared with the historical comparison group. At 28 days of age, the occurrence of chronic lung disease (CLD) was significantly lower (1/14 vs. 6/12, p < 0.05) and there was a significant decrease in the incidence of ventilator dependence (0/14 vs. 5/12, p < 0.05) in the DEX group. DEX therapy did not influence the incidence of significant complications such as infection, periventricular leukomalacia or retinopathy of prematurity. We conclude that in a selected high-risk group of preterm infants, early low-dose DEX treatment results in improvement in pulmonary outcome without significant side effects.
Tsukahara
H
H
Department of Pediatrics, Faculty of Medicine, Fukui Medical University, Fukui, Japan. htsuka@fmsrsa.fukui-med.ac.jp
Watanabe
Y
Y
Yasutomi
M
M
Kobata
R
R
Tamura
S
S
Kimura
K
K
Hiraoka
M
M
Mayumi
M
M
D001034:Apgar Score; D001724:Birth Weight; D001786:Blood Glucose / Q000032:analysis / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D002097:C-Reactive Protein / Q000032:analysis; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D005865:Gestational Age; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000000981:diagnostic imaging; D007969:Leukomalacia, Periventricular / Q000139:chemically induced; D008173:Lung Diseases, Obstructive / Q000517:prevention & control*; D008297:Male; D012123:Pulmonary Ventilation; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy*; D012178:Retinopathy of Prematurity / Q000139:chemically induced; D013501:Surface-Active Agents / Q000627:therapeutic use*; D014463:Ultrasonography
D001786:Blood Glucose; D005938:Glucocorticoids; D013501:Surface-Active Agents; D003907:Dexamethasone; D002097:C-Reactive Protein