Dexamethasone (Dex) is an effective drug in the treatment of bronchopulmonary dysplasia (BPD) and there is some evidence that early Dex may be better at reducing inflammation and minimizing lung damage. However Dex is a potent drug with potential serious side effects. We wished to identify which babies develop severe BPD and would therefore be potential candidates for early Dex. We retrospectively studied all babies < 1500 grams (g.) admitted to our NICU from Jan 95-Nov 96 to evaluate survival, surfactant (Surf) use for hyaline membrane disease (HMD), Dex use for BPD, the proportion of Surf babies who were candidates for Dex (* Surf+Dex/death), and babies who received Dex, but no Surf. Criteria for Surf: Xray compatible with HMD and arterial/alveolar pO2 ratio of <0.22. Criteria for Dex: Xray compatible with BPD in a ventilated baby with oxygen needs > 30%.

We found that Surf treatment for significant HMD strongly correlated with subsequent need for Dex for treatment of BPD in babies < 1000 g. (93% and 83% in Groups I and II, respectively), but correlated less well in Group III(60%) and Group IV (30%). Interestingly, one third of babies in all weight groups who received Dex for BPD did not have significant HMD initially, according to our criteria for Surf use at that time.

We conclude that significant HMD in babies < 1000 g. is a strong prognosticator for the development of severe BPD. This group of infants would be likely to eventually require Dex and therefore could be treated earlier. However, using this criteria alone would not identify one third of the infants who progress to significant BPD. Table

Table 1
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