Regional Neonatal Unit, Royal Maternity Hospital, Queen's University Belfast, Belfast, UK.
Neonatology. 2011;100(3):285-9. doi: 10.1159/000326273. Epub 2011 Jun 23.
Bronchopulmonary dysplasia (BPD) is a major respiratory complication of extreme prematurity. Dexamethasone is effective in reducing ventilation requirements in babies with BPD, but follow-up studies have raised concerns about long-term neurological sequelae. Few studies have investigated the lowest dose effective for weaning from mechanical ventilation.
Between January 2004 and December 2008 the practice in a tertiary neonatal unit was to use extremely low doses of dexamethasone for severe BPD, commencing at 0.05 mg/kg/day and decreasing over 9 days, with a cumulative dose of 0.24 mg/kg. The objective of this observational study was to assess the effectiveness of the extremely low-dose course in facilitating extubation.
The babies who had received extremely low-dose dexamethasone to facilitate weaning from mechanical ventilation were identified. Details of treatment and respiratory support were recorded. Serial oxygenation indices (OI) during the dexamethasone course were calculated, and these were analysed to assess the effect of treatment on ventilation requirements.
One hundred and ninety extremely preterm babies were admitted during this 5-year period. Sixteen babies received extremely low-dose dexamethasone. The median gestation was 25 weeks and the median birth weight was 644 g. Before starting dexamethasone, the median OI was 10.6, but by day 7 of treatment it had fallen to 5.4. By the end of the course, 12 of the 16 babies had been successfully extubated.
This short dexamethasone course appears effective in facilitating extubation. Randomised trials with long-term follow-up are needed to determine the role of extremely low-dose dexamethasone in preterm babies with evolving BPD.
支气管肺发育不良（BPD）是极早产儿的主要呼吸并发症。地塞米松可有效降低 BPD 患儿的通气需求，但后续研究对其长期神经后遗症提出了担忧。很少有研究调查过可有效实现从机械通气撤机的最低剂量。
在 2004 年 1 月至 2008 年 12 月期间，三级新生儿病房的治疗实践是使用极低剂量的地塞米松治疗严重 BPD，起始剂量为 0.05 mg/kg/天，持续 9 天，累积剂量为 0.24 mg/kg。本观察性研究的目的是评估极低剂量疗程在促进撤机方面的有效性。
确定了接受极低剂量地塞米松以促进从机械通气撤机的婴儿。记录了治疗和呼吸支持的详细信息。计算了地塞米松疗程期间的氧合指数（OI）系列，并对其进行分析，以评估治疗对通气需求的影响。
在 5 年期间，有 190 名极早产儿入住。16 名婴儿接受了极低剂量地塞米松治疗。中位胎龄为 25 周，中位出生体重为 644 克。开始地塞米松治疗前，OI 中位数为 10.6，但治疗第 7 天时已降至 5.4。疗程结束时，16 名婴儿中有 12 名成功撤机。
该短期地塞米松疗程似乎可有效促进撤机。需要进行长期随访的随机试验，以确定极低剂量地塞米松在患有进展性 BPD 的早产儿中的作用。
