Abstract 1083

A short course of early dexamethasone therapy with a starting dose of 0.5 mg/kg/day improves lung compliance and shortens the duration of ventilator support in preterm infants with respiratory distress syndrome (RDS) (Pediatrics 1995;95:584-590). We conducted a double-blind, randomized study to evaluate whether an early 14-day weaning course of low dose dexamethasone improves lung function and reduces potential side effects of dexamethasone (dex). Twenty-six preterm infants who required ventilator support for RDS on day 1 or 7-10 were randomized to a 14-day treatment course with dexamethasone (0.2 mg/kg/day start, tapering doses) or placebo (equivalent amounts of normal saline). Their gestational age was 28.8 ± 2.0 (24-32) weeks and their birth weight 1078 ± 295 (657-1767)g. They had been treated with surfactant and were ventilator-dependent at study entry with a mean airway pressure (MAP) of 6.6 cm H2) and FiO2 of 0.36 (Respiratory Index, RI, MAP × FiO2 = 2.67). In the dex and the control groups (n=13 each) average RI values were 1.32 and 2.13 on study day 1 (p=0.04), 1.09 and 1.38 on day 7, and 1.30 and 1.60 on day 14. Six dexamethasone and 0 control infants were weaned off the ventilator between days 5 and 7 of the study (p<0.001). Intraventricular hemorrhage grade 3-4 did not occur in the dex group and in 3 infants in the control group, sepsis was documented in 4 infants in each group. Insulin therapy for hyperglycemia control was given to 5 infants in the dex group and 2 in the control group. Highest mean arterial blood pressures during the study period were similar in the dex and control groups. Gastrointestinal did not occur in either group. Repeat steroids were given in 3 dex infants and 7 controls. These preliminary data suggest that an early 14-day weaning course of low dose dexamethasone accelerates weaning from the ventilator and affects glucose metabolism in very preterm infants. The long-term pulmonary and neurodevelopmental outcome in these infants requires additional investigation.

Supported by NIH grant P20 RR11145 and GCRC grant M01 RR00425.