We recently reported (Pediatrics 1995; 95:584-90) a significant increase in respiratory compliance, and a shorter duration of mechanical ventilation and O2 supplementation in VLBW infants receiving a 7-day weaning course of early dexamethasone (DEX) therapy (0.5 mg) when compared to controls. However, the ideal dose of DEX is still under investigation. In this study, we compared the effect of two different dose regimes of early DEX on mean airway pressure(MAP), FiO2, and duration of mechanical ventilation in 90 VLBW ventilator dependent infants at ≥7 days despite surfactant (BW 525-1220g; GA 23-30 weeks). Forty-five infants were randomized to receive high-dose DEX at 0.5 mg/kg/d IV for 3 days, 0.25 mg/kg/d for 3 days, and 0.1 mg/kg/d the 7th day; whereas 45 infants received a low-dose DEX as 0.2 mg/kg/d for 3 days and then 0.1mg/kg/d for 4 days. There was no difference between groups on the use of antenatal steroids. DEX reduced MAP and FiO2 in both groups of infants(p<0.05, Table). There was no significant difference between groups in duration of mechanical ventilation (26±15 vs 28±16 days, means±SD) or O2 supplementation at 36 weeks of corrected age (11% vs 15%). A transient increase in blood pressure and blood glucose was noted in both groups. We conclude: 1)Early low-dose DEX appears as effective as the high-dose DEX in decreasing MAP and FiO2 and facilitates extubation of VLBW infants; 2)The duration of mechanical ventilation and O2 supplementation at 36 weeks is comparable between groups. We speculate that low-dose DEX may minimize potential long-term side effects of DEX.
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McEvoy, C., Mendoza, M., Bowling, S. et al. Low-Dose Dexamethasone Therapy in Very Low Birth Weight (VLBW) Ventilator Dependent Infants (≤1250g): A Randomized Trial † 1073. Pediatr Res 43, 184 (1998). https://doi.org/10.1203/00006450-199804001-01094