Adrenal suppression and extubation rate after moderately early low-dose dexamethasone therapy in very preterm infants.
OBJECTIVE
A short course of moderately early dexamethasone therapy with a starting dose of 0.5 mg/kg/day improves lung compliance and shortens the duration of ventilatory support in preterm infants with respiratory distress syndrome (RDS). We conducted a double-blind, randomized study to evaluate whether a moderately early 14-day weaning course of low-dose dexamethasone affects adrenal function and facilitates weaning from the ventilator.


METHODS
Thirty-six preterm infants with a gestational age < or =32 weeks who required ventilatory support for RDS on days 7-14 were randomized to a 14-day treatment course with dexamethasone (0.2 mg/kg/day start, tapering doses) or placebo (equivalent amounts of normal saline). Prior to the first study treatment and the day after completion of the treatment course, adrenal function was assessed from serum cortisol levels drawn before and 30 min after intravenous administration of 0.1 mg Cortrosyn. Extubation rate during treatment in both groups was compared.


RESULTS
In both groups baseline serum cortisol levels decreased significantly during treatment, but stimulated cortisol levels did not change. After the 14-day treatment course, stimulated cortisol levels increased significantly from baseline levels in both groups (p<0.001), following Cortrosyn administration. More infants in the dexamethasone group were extubated within 7-14 days of study entry than in the placebo group (p<0.05). Hyperglycemia was more frequently diagnosed in the dexamethasone group and open-label dexamethasone treatment was given more frequently in the control group.


CONCLUSIONS
A moderately early 14-day weaning course of low-dose dexamethasone does not significantly suppress the adrenal function of very preterm infants with RDS, but accelerates weaning from the ventilator.
D000311:Adrenal Glands / Q000187:drug effects / Q000378:metabolism; D000309:Adrenal Insufficiency / Q000097:blood / Q000139:chemically induced*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003366:Cosyntropin / Q000627:therapeutic use; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007231:Infant, Newborn; D007275:Injections, Intravenous; D007363:Intensive Care Units, Neonatal; D008297:Male; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000378:metabolism; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications / Q000628:therapy*; D015300:Ventilator Weaning
D000893:Anti-Inflammatory Agents; D003366:Cosyntropin; D003907:Dexamethasone; D006854:Hydrocortisone