Recent studies suggest that early lung inflammation may play an important role for hypoxic respiratory failure in infants with MAS. To study whether early D therapy would improve clinical course and outcome, a double-blind randomized trial was undertaken on 50 infants (23 saline control C, 27 D) who had severe MAS (by X-Ray and by clinical RDS score of Downes et al > 6). Dexamethasone 1.0 mg/kg iv shortly after birth and then 0.5 mg/kg/dose q.12.h. on day 1-3; 0.25 mg/kg/dose q.12.h. on day 4-7. All infants had ET suction at birth. Both C and D had comparable B.W. (mean±SD 3.0±0.5 vs. 3.0±0.6 kg), G.A. (39.2±1.4 vs. 39.4±1.9 wk), Apgar score at and incidence of fetal distress. The first dose of D was given at 9.9± 8.3 hrs. (*p<.05, **p<.01) Table
More infants in C than in D remained intubated after d-3. Significantly lower PCO2 and higher pH were seen in D than in C on day 2-4 and day 3-4 respectively. Resp. set-up and FIO2, PO2 were comparable between the groups during the study. Infants in D required sign. (p<.05) shorter duration on IMV (3.5±3.1 d) than infants in C (4.6±3.0 d). There was no difference between the groups in mortality (C:1/23, D:2/27), CLD (C:0/23, D:0/27) and in duration of O2 therapy (C:6.6±5.8, D:7.0±4.1 d) and of hospitalization (C:14±6, D:14±5 d). A transient higher BP and glucose on day 2, 3 and on day 3, 5, 7 respectively and more weight loss on day 5 to 10 were seen in D than in C infants. We concluded that early D therapy for one week improved pul. Ventilation and facilitated weaning from IMV.
(Spon by: Tsu F. Yeh M.D.)
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Pediatric Research (1999)