Related Experiment Videos
A multicenter trial of two dexamethasone regimens in ventilator-dependent premature infants
L A Papile1, J E Tyson, B J Stoll
1University of New Mexico, Albuquerque, USA.
Insights
Starting dexamethasone therapy for premature infants at two weeks of age is more dangerous and offers no additional benefits compared to starting at four weeks. This finding impacts the optimal timing for dexamethasone treatment in ventilator-dependent infants.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Premature infants dependent on ventilators often receive dexamethasone.
- The optimal timing for initiating dexamethasone therapy remains undetermined.
Purpose of the Study:
- To compare the benefits and risks of initiating dexamethasone therapy at two weeks versus four weeks of age in ventilator-dependent very-low-birth-weight infants.
Main Methods:
- A study involving 371 ventilator-dependent very-low-birth-weight infants compared initiating dexamethasone at two weeks versus four weeks of age.
- Infants received either dexamethasone then placebo, or placebo then dexamethasone based on respiratory status.
- Dexamethasone was administered at 0.25 mg/kg twice daily, followed by a taper.
Main Results:
- No significant difference in the median time to ventilator independence (36 vs. 37 days) or chronic lung disease incidence (66% vs. 67%) was observed.
- Dexamethasone treatment was associated with increased risks of nosocomial bacteremia, hyperglycemia, elevated blood pressure, and diminished growth in both groups.
- Specific adverse events varied between early and later treatment groups.
Conclusions:
- Initiating dexamethasone therapy at two weeks of age in ventilator-dependent premature infants is more hazardous and not more beneficial than initiating at four weeks of age.
- The findings suggest that later initiation of dexamethasone may be preferable to minimize risks.
Background:
Ventilator-dependent premature infants are often treated with dexamethasone. However, the optimal timing of therapy is unknown.
Methods:
We compared the benefits and hazards of initiating dexamethasone therapy at two weeks of age and at four weeks of age in 371 ventilator-dependent very-low-birth-weight infants (501 to 1500 g) who had respiratory index scores (mean airway pressure x the fraction of inspired oxygen) of 52.4 at two weeks of age. One hundred eighty-two infants received dexamethasone for two weeks followed by placebo for two weeks, and 189 infants received placebo for two weeks followed by either dexamethasone (those with a respiratory-index score of > or =2.4 on treatment day 14) or additional placebo for two weeks. Dexamethasone was given at a dose of 0.25 mg per kilogram of body weight twice daily intravenously or orally for five days, and the dose was then tapered.
Results:
The median time to ventilator independence was 36 days in the dexamethasone-placebo group and 37 days in the placebo-dexamethasone group. The incidences of chronic lung disease (defined as the need for oxygen supplementation at 36 weeks' postconceptional age) were 66 percent and 67 percent, respectively. Dexamethasone was associated with an increased incidence of nosocomial bacteremia (relative risk, 1.5; 95 percent confidence interval, 1.1 to 2.1) and hyperglycemia (relative risk, 1.9; 95 percent confidence interval, 1.2 to 3.0) in the dexamethasone-placebo group, elevated blood pressure (relative risk, 2.9; 95 percent confidence interval, 1.2 to 6.9) in the placebo-dexamethasone group, and diminished weight gain and head growth (P< 0.001) in both groups.
Conclusions:
Treatment of ventilator-dependent premature infants with dexamethasone at two weeks of age is more hazardous and no more beneficial than treatment at four weeks of ages.