Early dexamethasone-attempting to prevent chronic lung disease

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Pharmacology

Background:

• Previous pilot trials suggested benefits of early intravenous dexamethasone for infants with respiratory distress syndrome.
• A multicenter, randomized, double-blind trial was conducted to validate these findings.

Purpose of the Study:

• To confirm improved survival and early outcomes in infants with surfactant-treated respiratory distress syndrome using a specific dose of intravenous dexamethasone.
• To evaluate the efficacy and safety of early dexamethasone administration.

Main Methods:

• 384 infants <30 weeks gestation requiring mechanical ventilation and surfactant were randomized.
• Infants received either dexamethasone (0.5mg/kg twice daily) or saline placebo.
• Exclusion criteria included suspected sepsis, pneumonia, congenital heart disease, or chromosomal abnormalities.

Main Results:

• No significant differences in survival, survival without oxygen at 36 weeks corrected gestational age (CGA), or survival without oxygen and late glucocorticoid therapy were observed.
• Early dexamethasone reduced the need for later glucocorticoid therapy for bronchopulmonary dysplasia (27% vs 35%).
• Among survivors, dexamethasone reduced median days on oxygen (37 vs 45) and ventilation (14 vs 19).

Conclusions:

• The studied dose of early intravenous dexamethasone did not improve survival or reduce oxygen requirements at 36 weeks CGA.
• Early dexamethasone decreased the use of later prolonged steroid therapy and improved outcomes in survivors.
• This regimen may represent a minimal dose for prophylaxis against bronchopulmonary dysplasia.