Early Use Of A Seven Day Course Of Dexamethasone Is More Likely To Require Additional Courses Of Steroid Therapy 992

Abstract

The use of a seven day course of dexamethasone for the treatment of bronchopulmonary dysplasia (BPD) has become common in many neonatal intensive care nurseries. Although studies have shown the early use of seven days of dexamethasone to improve pulmonary mechanics and reduce chronic lung disease, there remains a number of infants who require additional courses of steroid therapy. The purpose of this study was to retrospectively compare infants who were treated successfully with a single seven day course of dexamethasone to infants who required additional courses of therapy. Methods: A chart review of twenty-three patients who received a seven day course of dexamethasone from 6.95 to 11/96 was performed. Student's t-test was used to compare gestational age (GA), birth weight (BW), day of life dexamethasone was started and ventilator parameters before and after dexamethasone therapy. Treatment was considered successful if additional courses of dexamethasone were not required after the initial seven day course. Results: Thirteen of twenty-three patients (56%) were treated successfully with a single seven day course of dexamethasone. There were no differences in BW and GA between infants who required additional courses of dexamethasone (756±137g and 26±2.0 wks) and infants successfully treated (818±228g and 25.6±2.2 wks, p=0.4). Infants requiring additional courses of therapy were started on dexamethasone significantly earlier than infants who were treated successfully(11.3±6.5 vs. 21.5±14.4 days of life, p=0.05). A higher FiO_(2) and PIP was required at the time therapy was restarted compared to those same parameters at the completion of the 7 day course (p<0.03 and p<0.04, respectively). Conclusion: Although the early use of seven days of dexamethasone has been advocated for the treatment of BPD, these data suggest that infants treated earlier are more likely to require additional courses of therapy. We speculate that the infants receiving early dexamethasone may have been sicker which was not reflected by ventilator settings at the time of starting steroids.