Steroids in full term infants with respiratory failure and pulmonary hypertension due to meconium aspiration syndrome

• Published in: European journal of pediatrics Vol. 160; no. 3; pp. 150 - 153
• Main Authors: EUSTACE DA COSTA, David, ARUN KUMAR NAIR, MANGALORE GOVIND PAI, SALEH MOHAMMED AL KHUSAIBY
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Heidelberg Springer 01.03.2001; Berlin Springer Nature B.V
• Subjects: Analysis of Variance; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Delivery. Postpartum. Lactation; Dexamethasone - therapeutic use; Disorders; Female; Gynecology. Andrology. Obstetrics; Humans; Infant, Newborn; Male; Meconium Aspiration Syndrome - complications; Medical sciences; Oman - epidemiology; Persistent Fetal Circulation Syndrome - drug therapy; Persistent Fetal Circulation Syndrome - etiology; Persistent Fetal Circulation Syndrome - mortality; Pilot Projects; Prospective Studies; Respiratory Insufficiency - etiology; Respiratory Insufficiency - mortality; Respiratory Insufficiency - prevention & control; Survival Rate; Time Factors; Ventilator Weaning; Oman; Human; Lung disease; Corticosteroid; Dexamethasone; Pregnancy disorders; Respiratory disease; Aspiration; Treatment efficiency; Antiinflammatory agent; Cardiovascular disease; Pulmonary hypertension; Fetal diseases; Newborn diseases; Newborn; Treatment; Term pregnancy; Pulmonary regurgitation; Meconium
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s004310000678

Persistent pulmonary hypertension of the newborn (PPHN) due to meconium aspiration syndrome (MAS), has a high morbidity and mortality especially in centres with limited access to extra-corporeal membrane oxygenation or nitric oxide therapy. In such a setting, we conducted a pilot study to evaluate the effect of dexamethasone on severe respiratory failure with PPHN due to MAS with a view to exploring possible justification for randomised controlled trials in similar patients. We prospectively managed a consecutive case series of 14 infants over a 3-year period with the above mentioned diagnosis, who were ventilated and with an oxygenation index >25. Dexamethasone was commenced in a dose of 0.5 mg/kg per day and given for up to a maximum of 9 days in a reducing schedule. Differences between time points were analysed using analysis of variance for repeated measures. The mean age of commencing dexamethasone was 79.9 h. There was a rapid, significant improvement (P < 0.05) in the respiratory status in 13 of these infants after commencing dexamethasone, allowing weaning from the ventilator and eventual extubation at a mean age of 8.7 days. One infant died. Two infants had infective episodes. Conclusion. Dexamethasone, if started early in infants with respiratory failure and persistent pulmonary hypertension of the newborn due to meconium aspiration syndrome may be effective in improving gas exchange, and possibly avoiding extra-corporeal membrane oxygenation. A randomised controlled trial of using dexamethasone early in similar patients and setting is warranted.