Dexamethasone treatment in preterm infants at risk for bronchopulmonary dysplasia.

Abstract

A randomised double blind placebo controlled study was conducted to determine whether a one week course of dexamethasone could reduce the severity of bronchopulmonary dysplasia in preterm infants without compromising their adrenal function. Forty one infants with a mean birth weight of 880 g and a gestational age of 27 weeks who were ventilator dependent at 10 days of age were enrolled. At the age of 28 days pulmonary outcome was significantly better in the girls treated with dexamethasone but not in all infants. There was no difference between the groups in the long term outcome, except for a shorter duration of supplemental oxygen in dexamethasone treated female infants. After the one week dexamethasone treatment there was a significant but short lived suppression of the basal cortisol concentrations and the adrenal response to corticotrophin (ACTH). No serious side effects were observed.It is concluded that early one week dexamethasone treatment improves short term pulmonary outcome in premature infants, but there is no clear evidence of long term benefits.

Dexamethasone Treatment of Infants at Risk for Chronic Lung Disease: Surfactant Components and Inflammatory Parameters in Airway Specimens

“…Steroids may have a somewhat different mechanism of action in CLD or early CLD from that detected in prenatal treatment. Several studies have failed to show a sustained beneficial effect of DEX in preterm infants when the treatment was discontinued (3,5,18). It has been speculated that respiratory failure seen after discontinuation of DEX is related to the return of the inflammatory state (5).…”

“…According to current evidence, DEX treatment of preterm ventilator-dependent infants with threatened CLD decreases the requirements of ventilatory support (3,5,7,8,16,18) and improves pulmonary mechanics (4-6). DEX treatment has decreased the concentrations of albumin in lung effluent (5,15,16), suggesting decreased endothelial and epithelial permeability.…”

“…They participated in the randomized, multicenter study of DEX therapy in infants at risk for CLD and composed 56% of all infants participating in this study (18). AS were available from all infants who were recruited into the study at the Children's Hospital, University of Helsinki.…”

“…We performed a randomized PL-controlled multicenter trial on very-low-birth-weight infants, who were ventilator and oxygen dependent at the age of 10 d (18). Within the context of the trial, our aim was to investigate whether administration of DEX was associated with changes in inflammatory indices, surfactant components, or surface activity in the E L F and whether any of these parameters correlated with the pulmonary outcome.…”

Prospective Evaluation of Postnatal Steroid Administration: A 1-Year Experience From the California Perinatal Quality Care Collaborative

“…19,20 Other prospective trials have also reported a high incidence of other adverse effects, including an increase in nosocomial sepsis, meningitis, and hyperglycemia 21,22 ; hypertriglyceridemia; increased free fatty acid levels 23 ; increased protein catabolism and poorer somatic growth [24][25][26] ; and pituitary-adrenal suppression, 27 which can last for 1 month after therapy. 28,29 None of the published trials evaluating PNSs were powered to evaluate long-term follow-up. A number of reports, many describing follow-up studies of infants enrolled in randomized, controlled trials of PNSs to prevent or ameliorate bronchopulmonary dysplasia (BPD), noted that such use was associated with a significantly increased occurrence of neurodevelopmental impairment, especially if the risk of the development of CLD was Ͻ35% in the control infants.…”