Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: A multicenter, international, randomized, controlled trial

Lex W. Doyle, Peter G. Davis, Colin J. Morley, Andy McPhee, John B. Carlin, M. Kaimakamis, C. Callanan, V. Yu, M. Hayes, R. Li, S. Fraser, A. Gill, R. Lontis, L. Goodchild, N. French, N. Evans, S. Reid, B. Darlow, C. Kuschel, R. AlvaroA. Chiu, K. Sankaran, K. Jamsen, J. Hiller, J. Lumley, J. C. Sinclair

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Abstract

OBJECTIVE. Postnatal corticosteroid therapy is controversial. The aim of this study was to determine the short-term effects of low-dose dexamethasone treatment among chronically ventilator-dependent neonates. METHODS. Very preterm (gestational age: <28 weeks) or extremely low birth weight (birth weight: <1000 g) infants who were ventilator dependent after the first 1 week of life were eligible and were assigned randomly to receive masked dexamethasone (0.89 mg/kg over 10 days) or saline placebo. Data on ventilator and oxygen requirements and deaths were recorded. RESULTS. Seventy infants were recruited from 11 centers, at a median age of 23 days. More infants were extubated successfully by 10 days of treatment in the dexamethasone group (60%, 21 of 35 patients) than in the control group (12%, 4 of 34 patients) (odds ratio [OR]: 11.2; 95% confidence interval [CI]: 3.2-39.0). Ventilator and oxygen requirements improved substantially, and the duration of intubation was shorter. There was little evidence for a reduction in either the mortality rate (dexamethasone group: 11%; control group: 20%; OR: 0.52; 95% CI: 0.14-1.95) or the rate of oxygen dependence at 36 weeks (dexamethasone group: 85%; control group: 91%; OR: 0.58; 95% CI: 0.13-2.66). There were no obvious effects of low-dose dexamethasone on blood glucose concentrations, blood pressure, or other complications. No infant experienced intestinal perforation. CONCLUSIONS. Low-dose dexamethasone treatment after the first 1 week of life clearly facilitates extubation and shortens the duration of intubation among ventilator-dependent, very preterm/extremely low birth weight infants, without any obvious short-term complications. Combined with recent evidence that infants at very high risk of bronchopulmonary dysplasia may benefit in the long term, our study reopens debate regarding the role of low-dose, late postnatal, corticosteroid therapy.

Original languageEnglish
Pages (from-to)75-83
Number of pages9
JournalPediatrics
Volume117
Issue number1
DOIs
Publication statusPublished - 1 Jan 2006

Keywords

  • Bronchopulmonary dysplasia
  • Extubation
  • Infant
  • Low birth weight
  • Low-dose dexamethasone
  • Preterm

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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