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Dexamethasone treatment during ventilator dependency: possible life threatening gastrointestinal complications
E A O'Neil1, W J Chwals, M D O'Shea
1Department of Surgery, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157-1095.
Insights
High-dose corticosteroids can reduce ventilator dependency in premature infants but carry risks. Physicians should monitor for gastrointestinal complications like ulcers and bleeding when using these treatments.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Pharmacology
Background:
- High-dose corticosteroids are utilized to shorten ventilator duration in very low birthweight (VLBW) infants.
- Previous randomized trials indicated benefits with minimal complications.
Observation:
- A review of 80 premature neonates treated with high-dose steroids over 2.5 years identified significant gastrointestinal complications.
- Three major complications occurred: perforated duodenal ulcer, perforated gastric ulcer, and upper gastrointestinal hemorrhage.
- Two of the three patients with these complications did not survive.
Findings:
- The use of high-dose corticosteroids in neonates is associated with serious risks.
- Significant complications, including upper gastrointestinal bleeding and ulcer perforation, can arise.
Implications:
- When administering high-dose corticosteroids to VLBW neonates, concurrent H2 receptor antagonist therapy and gastric pH monitoring are advised.
- Clinicians must maintain vigilance for potential upper gastrointestinal bleeding and ulcer perforation in these vulnerable infants.
Abstract:
Corticosteroids in high doses have been used effectively to decrease the duration of ventilator dependency in very low birthweight infants at risk for chronic lung disease. Randomised prospective studies have shown benefit, with only minimal complications being reported. However, review of our experience over 2.5 years with high dose steroids in 80 premature neonates yielded three major complications: one case each of perforated duodenal ulcer, perforated gastric ulcer, and upper gastrointestinal haemorrhage. Two of the three patients died. Thus the use of steroids in neonates may not be without risk, and significant complications can occur. When high dose corticosteroids are to be used in very low birthweight neonates, H2 receptor antagonist treatment and gastric pH monitoring are recommended. The physician must remain alert to the possibilities of upper gastrointestinal bleeding and ulcer perforation in these patients.