[Dexamethasone in the treatment of bronchopulmonary dysplasia].

Dexamethasone has been reported to benefit premature infants with bronchopulmonary dysplasia. 13 ventilator-dependent premature infants (birth weight 780-1270 g) with chronic lung disease received dexamethasone 0.5 mg/kg/day with tapering doses over 3 weeks. Dexamethasone therapy was associated with a temporary increase in urine output and blood pressure. All infants showed a significant fall in oxygen requirement and an increase of total pulmonary compliance during the first week. The endotracheal tube was successfully removed in all infants with Northway stage I/II BPD within the first week of treatment and no infant relapsed. But in Northway stage III/IV, only 2/9 infants could be weaned from the ventilator during the first course of treatment and in the majority treatment led only to a temporary improvement of pulmonary status. In parallel to the improvement of lung function we found in 7 infants a decrease of the total cell counts, the ratio PMN/macrophages and albumin in relation to urea in the bronchial lavages with a secondary rise in cases of a clinical relapse. Free elastase and fibronectin/albumin ratio in the bronchial lavage did not correlate to the clinical course. Dexamethasone seems to have not only an effect on fluid balance but also on the alveolar capillary leakage and the PMN influx into the lung. This might explain the superior effect of dexamethasone in patients with Northway stage I/II BPD in comparison to infants with Northway stage III/IV.