Postnatal betamethasone vs dexamethasone in premature infants with bronchopulmonary dysplasia: a pilot study.
OBJECTIVE
As effects of glucocorticoids differ with respect to preparation, dose and duration, we hypothesized that a postnatal regimen of a low-dose, short-course betamethasone treatment had comparable efficacy and a better safety profile compared to the conventional high-dose, dexamethasone.


METHODS
To test our hypothesis, we selected premature neonates with a birth weight <or=1000 g and a gestational age <or=29 weeks who were ventilated >10 postnatal days with an FiO(2)>0.4 and no ability to wean mechanical support for >or=3 consecutive days. These neonates either received twice daily dexamethasone 0.25 mg kg(-1) per dose intravenously for 3 days tapered to 0.125 mg kg(-1) per dose for 4 days (June 1999 to December 2000) or betamethasone 0.125 mg kg(-1) per day intramuscularly once per day for 3 days (January 2001 to December 2002).


RESULTS
We found a significant reduction in FiO(2) after 3 days in both glucocorticoid treatment groups. There were no significant differences between the two treatment groups in the clinical parameters including decrease in FiO(2), oxygenation index, mean airway pressure and percent extubation. Duration of ventilation, number of oxygen days and length of hospital stay were comparable in the two groups. Of particular interest, the betamethasone group showed fewer adverse effects, such as poor weight gain and high blood glucose, than the dexamethasone group.


CONCLUSIONS
A short course of low-dose betamethasone has comparable efficacy and seemingly a better short-term safety profile compared to conventional dexamethasone treatment.
DeCastro
M
M
Division of Newborn Medicine, Department of Pediatrics, Regional Neonatal Center, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.
El-Khoury
N
N
Parton
L
L
Ballabh
P
P
LaGamma
E F
EF
D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001623:Betamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy*; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007273:Injections, Intramuscular; D007902:Length of Stay; D008297:Male; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D015300:Ventilator Weaning
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D001623:Betamethasone; D010100:Oxygen