Abstract
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 (VA/Q) and the fraction of required oxygen (FIO2) 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 VA/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), p = 0.001]. The FIO2 requirement decreased from 0.70 (0.59–0.79) to 0.34 (0.28–0.52) nine days after starting the course (p < .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.
Acknowledgments
The secretarial assistance of Mrs Deirdre Gibbons is gratefully acknowledged.
Ethical approval
The study was registered with the Clinical Governance Department of KCH. The Health Research Authority Toolkit of the National Health System, United Kingdom confirmed that the study was not considered as research and hence would not need regulatory approval by a research ethics committee.
Author contributions
TD conceived the study, analyzed the data and wrote the first version of the manuscript. OK participated in the design of the study, collected the data and approved the final version of the manuscript. AG supervised the project, contributed to the interpretation of the results and critically revised the manuscript.
Disclosure statement
No potential conflict of interest was reported by the author(s).