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Early postnatal dexamethasone for the prevention of chronic lung disease in high-risk preterm infants
C Romagnoli1, E Zecca, G Vento
1Division of Neonatology, Catholic University of the Sacred Heart, Rome, Italy. cromagnoli@rm.unicatt.it
Insights
Early dexamethasone administration significantly reduced chronic lung disease (CLD) in high-risk preterm infants. This steroid treatment also shortened ventilation and oxygen needs but caused transient side effects.
Area of Science:
- Neonatalogy
- Pediatric Pulmonology
- Pharmacology
Background:
- Chronic lung disease (CLD) is a significant complication in preterm infants.
- Early intervention strategies are crucial for improving outcomes in high-risk neonates.
Purpose of the Study:
- To assess the efficacy of early dexamethasone administration in preventing CLD in high-risk preterm infants.
- To identify and evaluate the side effects associated with early steroid use.
Main Methods:
- A randomized clinical trial was conducted in a neonatal intensive care unit.
- 50 high-risk preterm infants were randomized to receive either dexamethasone or a control (no steroid treatment).
- Dexamethasone was administered intravenously for 7 days, starting after 72 hours of life.
Main Results:
- The incidence of CLD was significantly lower in the dexamethasone group at 28 days and 36 weeks postconceptional age (p < 0.001).
- Infants receiving dexamethasone required shorter durations of intubation and oxygen therapy (p < 0.001).
- Transient side effects included hyperglycemia, hypertension, growth failure, and left ventricular hypertrophy.
Conclusions:
- Early dexamethasone administration demonstrates potential in preventing CLD in preterm infants.
- The use of early dexamethasone should be carefully considered and limited to high-risk preterm infants.
Objective:
The purpose of this study was to evaluate the effect of early administration of dexamethasone on the incidence of chronic lung disease (CLD) in high risk preterm infants and to evaluate the side effects of the early steroid administration.
Design:
Randomised clinical trial.
Setting:
Neonatal intensive care unit.
Patients:
50 infants at high risk of CLD were randomly assigned after 72 h of life to the dexamethasone group (n = 25) or to the control group (n = 25). The treated infants received dexamethasone intravenously from the 4th day of life for 7 days (0.5 mg/kg per day for the first 3 days, 0.25 mg/kg per day for the next 3 days and 0.125 mg/kg per day on the 7th day). The control group received no steroid treatment.
Results:
The incidence of CLD at 28 days of life and at 36 weeks' postconceptional age was significantly lower in the dexamethasone group than in the control group (p < 0.001). Moreover, infants in the dexamethasone group remained intubated and required oxygen therapy for a shorter period than those in the control group (p < 0.001). Hyperglycaemia, hypertension, growth failure and mainly hypertrophy of the left ventricle were the transient side effects associated with early steroid administration.
Conclusions:
Early dexamethasone administration may be useful in preventing CLD, but its use should prudently be restricted to preterm infants at high risk of CLD.