A single very early dexamethasone dose improves respiratory and cardiovascular adaptation in preterm infants

• Published in: The Journal of pediatrics Vol. 135; no. 3; pp. 345 - 350
• Main Authors: Kopelman, Arthur E., Moise, Alicia A., Holbert, Donald, Hegemier, Suzanne E.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.1999; Elsevier
• Subjects: Adaptation, Physiological - drug effects; Anti-Inflammatory Agents - pharmacology; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Blood Pressure - drug effects; Cardiovascular Physiological Phenomena - drug effects; Cause of Death; Cerebral Hemorrhage - mortality; Cerebral Hemorrhage - prevention & control; Cerebral Ventricles; Dexamethasone - pharmacology; Dexamethasone - therapeutic use; Female; Humans; Infant, Newborn; Infant, Premature, Diseases - mortality; Infant, Premature, Diseases - prevention & control; Male; Medical sciences; Pharmacology. Drug treatments; Postnatal Care - methods; Prospective Studies; Respiratory Physiological Phenomena - drug effects; Respiratory system; Single-Blind Method; Time Factors; IMV; PIP; BPD; NICU; IVH; MBP; PDA; Human; Premature; Corticosteroid; Dexamethasone; Single dose; Cardiopulmonary; Controlled therapeutic trial; Prospective; Prevention; Chemotherapy; Randomization; Complication; Early; Adaptation
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(99)70132-0

Objectives: To test the hypothesis that a single dose of dexamethasone given soon after delivery to infants <28 weeks’ gestation leads to improved cardiopulmonary adaptation in the first week and lowers the risk of significant intraventricular hemorrhage. Methods: In a prospective, blinded, placebo-controlled study, we randomly assigned 70 infants <28 weeks’ gestation who were born in the hospital to receive dexamethasone (0.2 mg/kg) (n = 37) or normal saline solution (n = 33) within 2 hours of delivery. After an interim analysis showed that the incidence of intraventricular hemorrhage was much lower than expected, enrollment was stopped and we limited our analysis to a comparison of ventilator settings, blood pressure, and pressor use during the first 7 days. Results: Clinical characteristics of the groups were comparable at study entry. Ventilator weaning occurred more rapidly in the patients who received dexamethasone: their intermittent mandatory ventilation rate was significantly lower on days 1 through 6, and their peak inspiratory pressure was lower on days 3 through 7 compared with the control group. Mean blood pressures were higher in the dexamethasone group within 12 hours and remained higher through day 5, but the use of pressors was not different. Fewer infants in the dexamethasone group received indomethacin to treat a patent ductus arteriosus (22% vs 47%, P < .03). Conclusion: Dexamethasone given within 2 hours of delivery to preterm infants <28 weeks’ gestation resulted in lower ventilator settings and higher mean blood pressures during the first 7 days. Fewer infants required indomethacin to treat a patent ductus arteriosus. (J Pediatr 1999;135:345-50)