Abstract
Background: Corticosteroids (CS) given after birth in ventilator dependent infants facilitate extubation and reduce the rate of chronic lung disease, whether they are given early, moderately early, or later in the newborn period. However, recent controversy about adverse long-term effects of corticosteroids on the brain have led to a decrease in the use of CS, or to prescribing of smaller doses than shown to work in the existing randomised trials. The DART study was an international multicentre randomised controlled trial that had as its main aim to assess the effects of low-dose dexamethasone on long-term survival free of major neurologic disability. However, enrollment had to stop when recruitment fell to a rate that was too low to complete the study. A secondary aim of the DART study was to determine acute effects of low dose dexamethasone.
Aim: To determine the acute respiratory effects of low-dose dexamethasone, given after the first week of life, in ventilator-dependent very preterm/extremely low birthweight (ELBW) infants.
Methods: Very preterm (<28 weeks) or ELBW (birthweight <1000g) infants who were ventilator dependent after the first week of life and in whom the clinician considered corticosteroids were a treatment option were eligible for the study. After informed consent, infants were randomly allocated to receive either a 10-day tapering course of dexamethasone (0.89 mg/kg total over 10-days) or saline placebo. Random allocation was balanced within individual participating centres. Data were recorded on demographic variables, and ventilator settings at baseline and daily through the 10 days of treatment. Oxygen requirements at 36 weeks post-menstrual age were recorded.
Results: A total of 70 infants were recruited from 11 centres. The infants were comparable at baseline, with overall mean gestational ages of 24.9 (SD 1.3) weeks, birthweights of 701 (140) g, and postnatal ages of 24.6 (12.6) days. More infants were successfully extubated by 10 days in the dexamethasone group than in the controls (odds ratio 11.2, 95% CI 2.9, 51.6; P<0.001). The mortality rate appeared lower in the dexamethasone group but the comparison lacked precision (OR 0.52, 95% CI 0.10, 2.31; P= 0.32). There was little evidence for a reduction in the rate of oxygen dependency at 36 weeks (OR 0.58, 95% CI 0.08, 3.32; P= 0.71).
Conclusions: Low dose dexamethasone clearly facilitates extubation in ventilator-dependent very preterm/ELBW infants after the first week of life.
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Doyle, L., Davis, P., Morley, C. et al. 76 Low Dose Dexamethasone Facilitates Extubation in Ventilator-Dependent Infants - A Multicentre International Randomised Controlled Trial. The Dart Study Investigators. Pediatr Res 56, 477 (2004). https://doi.org/10.1203/00006450-200409000-00099
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DOI: https://doi.org/10.1203/00006450-200409000-00099