Second course of systemic dexamethasone: efficacy and respiratory function changes.

BACKGROUND

There is a paucity of data concerning the efficacy of a second course of systemic postnatal corticosteroids resulting in a successful extubation of prematurely-born, ventilated infants and its effect on their respiratory function.

OBJECTIVES

To determine the efficacy of a second course of systemic dexamethasone in successful extubation of prematurely-born infants and to describe the respiratory function changes that occur following the administration of the second course.

METHODS

Retrospective cohort study of ventilated infants less than 30 weeks of gestation who received a nine-day second course of intravenous dexamethasone in a tertiary neonatal unit. Extubation was deemed successful if the infants were not re-intubated within 72 h of the extubation attempt. We calculated the ventilation perfusion ratio (V/Q) and the fraction of required oxygen (FO) requirement expressed as a percentage before and after the course.

RESULTS

Fifteen (10 male) infants with a median (IQR) gestational age (GA) of 25.7 (24.7-26.6) weeks and a birth weight of 0.79 (0.67-0.93) kg were studied at a postnatal age of 60 (48-73) days. Fourteen of fifteen infants (93%) were successfully extubated. The V/Q before the course was 0.13 (0.11-0.16) and significantly higher at 72 h after starting the course [0.26 (0.19-0.36),  = 0.001]. The FO requirement decreased from 0.70 (0.59-0.79) to 0.34 (0.28-0.52) nine days after starting the course ( < .001).

CONCLUSIONS

A second course of systemic dexamethasone appears efficient in weaning premature infants off invasive ventilation and is associated with a significant improvement in oxygenation.