Gunes Sezgin, Sahin Suzan, Bozkurt Ozlem, Cezayir Begum, Bozgul Arda, Gonulal Deniz, Oncel Mehmet Yekta
Department of Neonatology, Buca Seyfi Demirsoy Teaching and Research Hospital, Izmir, Türkiye.
Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Izmir Democracy University, Izmir, Türkiye.
Front Pediatr. 2025 Aug 7;13:1603308. doi: 10.3389/fped.2025.1603308. eCollection 2025.
Premature infants are particularly vulnerable to complications such as bronchopulmonary dysplasia (BPD). Although systemic steroids have been used for some time, no effective alternative treatments have emerged. This has led clinicians to investigate various dosing regimens and discuss the necessity of revising systemic steroid dosages. This study aims to evaluate the effectiveness and safety of two different doses of systemic dexamethasone use in treating BPD in premature infants born at or below 30 weeks of gestation.
A retrospective review was conducted on hospital records of premature infants admitted to the Neonatal Intensive Care Unit of Izmir Private Medicalpark Hospital for a 6-year period. In the first 2 years of these 6 years, as historical controls, infants with evolving BPD had received dexamethasone treatment according to the DART protocol, while the ones born in the last 4 years received enhanced low-dose treatment. Data collected included demographic characteristics, risk factors for preterm birth, duration and way of oxygen support, prematurity-related complications, systemic dexamethasone doses, and mortality.
Of the 368 infants analyzed in the study, 265 had received systemic enhanced low dose dexamethasone, while 103 had received low dose dexamethasone treatment. Baseline characteristics including gestational age, birth weights, and RDS severity were similar among groups The study found that a cumulative dose of 1.35 mg/kg of systemic dexamethasone (enhanced low dose) is both safe and more effective than standard low dose dexamethasone (DART protocole) therapy in the management of BPD. The DART group required significantly longer invasive and non-invasive ventilatory support compared to the enhanced low-dose group. By the 36th gestational week, a higher proportion of infants in the enhanced low-dose group were free from oxygen support. The enhanced low-dose group also had a higher extubation success rate. Dexamethasone -related side effects were minimal, with only two cases of hypertension and one of interventricular septal hypertrophy in the enhanced low dose group, and one case of hypertension in the DART group, all resolving over time.
Our study suggests that an enhanced low-dose dexamethasone regimen (1.35 mg/kg) may offer superior respiratory outcomes compared to the conventional DART protocol without a significant increase in short-term adverse effects.
早产儿特别容易出现诸如支气管肺发育不良（BPD）等并发症。尽管全身用类固醇已经使用了一段时间，但尚未出现有效的替代治疗方法。这促使临床医生研究各种给药方案，并讨论修订全身用类固醇剂量的必要性。本研究旨在评估两种不同剂量的全身用地塞米松用于治疗孕周30周及以下早产儿BPD的有效性和安全性。
对伊兹密尔私立医疗公园医院新生儿重症监护病房收治的早产儿6年的医院记录进行回顾性研究。在这6年的前2年，作为历史对照，患有进展性BPD的婴儿按照DART方案接受地塞米松治疗，而在最后4年出生的婴儿接受强化低剂量治疗。收集的数据包括人口统计学特征、早产风险因素、氧气支持的持续时间和方式、早产相关并发症、全身用地塞米松剂量和死亡率。
在该研究分析的368名婴儿中，265名接受了全身强化低剂量地塞米松治疗，而103名接受了低剂量地塞米松治疗。各治疗组间包括胎龄、出生体重和呼吸窘迫综合征严重程度在内的基线特征相似。该研究发现，在BPD的治疗中，累积剂量为1.35mg/kg的全身用地塞米松（强化低剂量）比标准低剂量地塞米松（DART方案）疗法既安全又更有效。与强化低剂量组相比，DART组需要显著更长时间的有创和无创通气支持。到孕36周时，强化低剂量组中更高比例的婴儿无需氧气支持。强化低剂量组的拔管成功率也更高。地塞米松相关的副作用极小，强化低剂量组仅出现2例高血压和1例室间隔肥厚，DART组出现1例高血压，所有这些均随时间推移而缓解。
我们的研究表明，与传统的DART方案相比，强化低剂量地塞米松方案（1.35mg/kg）可能提供更好的呼吸结局，且不会显著增加短期不良反应。
