Effects of early dexamethasone therapy on pulmonary mechanics and chronic lung disease in very low birth weight infants: A randomized, controlled trial

M. Durand, S. Sardesai, Cynthia (Cindy) McEvoy

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Objective. To determine the changes in pulmonary mechanics before and during early dexamethasone therapy, and to evaluate the effect of dexamethasone on the duration of mechanical ventilation in very low birth weight (VLBW) ventilator-dependent infants at risk for chronic lung disease (CLD). Methods. A prospective randomized trial was conducted. Forty-three patients (birth weight 600 to 1500 g, gestational age 24 to 32 weeks) who failed to be weaned from the respirator at 7 to 14 days of age were enrolled; 23 infants received a 7-day course of dexamethasone (0.5 mg/kg/day intravenously for 3 days, 0.25 mg/kg/day for 3 days, and 0.1 mg/kg/day for 1 day), and 20 patients were in the control group. At similar mean airway pressure (MAP) and fractional inspired oxygen concentration (FiO2), respiratory system mechanics were measured before and on days 2, 5, and 7 of the study. Airway pressure, flow and tidal volume (V(T)) were recorded and only mechanical breaths were analyzed. Respiratory compliance (C(rs)) and respiratory resistance (R(rs)) were calculated by two factor least mean square analysis. Results. Eighty-three percent of infants in the dexamethasone group and 90% in the control group received surfactant in the first 24 hours of life. There was a significant increase in C(rs) and V(T) in the dexamethasone group as compared with the control group (P <.001). No major changes in R(rs) were observed. Dexamethasone therapy significantly decreased FiO2 and MAP P <.001) and facilitated successful weaning from mechanical ventilation. In addition to a shorter duration of mechanical ventilation (P <.01), the occurrence of CLD (FiO2 > 0.21 at 36 weeks of corrected gestational age, chest radiograph changes) was significantly decreased in the dexamethasone group (P <.01). Except for a transient increase in blood pressure and serum glucose, there were no significant differences in infection rates, intraventricular hemorrhage, or retinopathy of prematurity. Thirteen patients in the control group received dexamethasone at a later age. Conclusions. Our findings indicate that: 1) early dexamethasone therapy in VLBW infants markedly improves respiratory compliance and tidal volume, reduces FiO2 and MAP requirements, and facilitates extubation in these infants; 2) early dexamethasone therapy reduces the duration of mechanical ventilation and decreases CLD (at 28 days and 36 weeks) in a population of VLBW infants largely treated with surfactant.

Original languageEnglish (US)
Pages (from-to)584-590
Number of pages7
JournalPediatrics
Volume95
Issue number4
StatePublished - 1995
Externally publishedYes

Fingerprint

Very Low Birth Weight Infant
Secondary Prevention
Mechanics
Dexamethasone
Lung Diseases
Chronic Disease
Randomized Controlled Trials
Lung
Control Groups
Tidal Volume
Mechanical Ventilators
Artificial Respiration
Pressure
Surface-Active Agents
Gestational Age
Compliance
Respiratory Mechanics
Retinopathy of Prematurity
Least-Squares Analysis
Birth Weight

Keywords

  • chronic lung disease
  • dexamethasone therapy
  • respiratory mechanics
  • very low birth weight infants

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{c3fefea7cce5425d948c55d3b9afaa3d,
title = "Effects of early dexamethasone therapy on pulmonary mechanics and chronic lung disease in very low birth weight infants: A randomized, controlled trial",
abstract = "Objective. To determine the changes in pulmonary mechanics before and during early dexamethasone therapy, and to evaluate the effect of dexamethasone on the duration of mechanical ventilation in very low birth weight (VLBW) ventilator-dependent infants at risk for chronic lung disease (CLD). Methods. A prospective randomized trial was conducted. Forty-three patients (birth weight 600 to 1500 g, gestational age 24 to 32 weeks) who failed to be weaned from the respirator at 7 to 14 days of age were enrolled; 23 infants received a 7-day course of dexamethasone (0.5 mg/kg/day intravenously for 3 days, 0.25 mg/kg/day for 3 days, and 0.1 mg/kg/day for 1 day), and 20 patients were in the control group. At similar mean airway pressure (MAP) and fractional inspired oxygen concentration (FiO2), respiratory system mechanics were measured before and on days 2, 5, and 7 of the study. Airway pressure, flow and tidal volume (V(T)) were recorded and only mechanical breaths were analyzed. Respiratory compliance (C(rs)) and respiratory resistance (R(rs)) were calculated by two factor least mean square analysis. Results. Eighty-three percent of infants in the dexamethasone group and 90{\%} in the control group received surfactant in the first 24 hours of life. There was a significant increase in C(rs) and V(T) in the dexamethasone group as compared with the control group (P <.001). No major changes in R(rs) were observed. Dexamethasone therapy significantly decreased FiO2 and MAP P <.001) and facilitated successful weaning from mechanical ventilation. In addition to a shorter duration of mechanical ventilation (P <.01), the occurrence of CLD (FiO2 > 0.21 at 36 weeks of corrected gestational age, chest radiograph changes) was significantly decreased in the dexamethasone group (P <.01). Except for a transient increase in blood pressure and serum glucose, there were no significant differences in infection rates, intraventricular hemorrhage, or retinopathy of prematurity. Thirteen patients in the control group received dexamethasone at a later age. Conclusions. Our findings indicate that: 1) early dexamethasone therapy in VLBW infants markedly improves respiratory compliance and tidal volume, reduces FiO2 and MAP requirements, and facilitates extubation in these infants; 2) early dexamethasone therapy reduces the duration of mechanical ventilation and decreases CLD (at 28 days and 36 weeks) in a population of VLBW infants largely treated with surfactant.",
keywords = "chronic lung disease, dexamethasone therapy, respiratory mechanics, very low birth weight infants",
author = "M. Durand and S. Sardesai and McEvoy, {Cynthia (Cindy)}",
year = "1995",
language = "English (US)",
volume = "95",
pages = "584--590",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "4",

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TY - JOUR

T1 - Effects of early dexamethasone therapy on pulmonary mechanics and chronic lung disease in very low birth weight infants

T2 - A randomized, controlled trial

AU - Durand, M.

AU - Sardesai, S.

AU - McEvoy, Cynthia (Cindy)

PY - 1995

Y1 - 1995

N2 - Objective. To determine the changes in pulmonary mechanics before and during early dexamethasone therapy, and to evaluate the effect of dexamethasone on the duration of mechanical ventilation in very low birth weight (VLBW) ventilator-dependent infants at risk for chronic lung disease (CLD). Methods. A prospective randomized trial was conducted. Forty-three patients (birth weight 600 to 1500 g, gestational age 24 to 32 weeks) who failed to be weaned from the respirator at 7 to 14 days of age were enrolled; 23 infants received a 7-day course of dexamethasone (0.5 mg/kg/day intravenously for 3 days, 0.25 mg/kg/day for 3 days, and 0.1 mg/kg/day for 1 day), and 20 patients were in the control group. At similar mean airway pressure (MAP) and fractional inspired oxygen concentration (FiO2), respiratory system mechanics were measured before and on days 2, 5, and 7 of the study. Airway pressure, flow and tidal volume (V(T)) were recorded and only mechanical breaths were analyzed. Respiratory compliance (C(rs)) and respiratory resistance (R(rs)) were calculated by two factor least mean square analysis. Results. Eighty-three percent of infants in the dexamethasone group and 90% in the control group received surfactant in the first 24 hours of life. There was a significant increase in C(rs) and V(T) in the dexamethasone group as compared with the control group (P <.001). No major changes in R(rs) were observed. Dexamethasone therapy significantly decreased FiO2 and MAP P <.001) and facilitated successful weaning from mechanical ventilation. In addition to a shorter duration of mechanical ventilation (P <.01), the occurrence of CLD (FiO2 > 0.21 at 36 weeks of corrected gestational age, chest radiograph changes) was significantly decreased in the dexamethasone group (P <.01). Except for a transient increase in blood pressure and serum glucose, there were no significant differences in infection rates, intraventricular hemorrhage, or retinopathy of prematurity. Thirteen patients in the control group received dexamethasone at a later age. Conclusions. Our findings indicate that: 1) early dexamethasone therapy in VLBW infants markedly improves respiratory compliance and tidal volume, reduces FiO2 and MAP requirements, and facilitates extubation in these infants; 2) early dexamethasone therapy reduces the duration of mechanical ventilation and decreases CLD (at 28 days and 36 weeks) in a population of VLBW infants largely treated with surfactant.

AB - Objective. To determine the changes in pulmonary mechanics before and during early dexamethasone therapy, and to evaluate the effect of dexamethasone on the duration of mechanical ventilation in very low birth weight (VLBW) ventilator-dependent infants at risk for chronic lung disease (CLD). Methods. A prospective randomized trial was conducted. Forty-three patients (birth weight 600 to 1500 g, gestational age 24 to 32 weeks) who failed to be weaned from the respirator at 7 to 14 days of age were enrolled; 23 infants received a 7-day course of dexamethasone (0.5 mg/kg/day intravenously for 3 days, 0.25 mg/kg/day for 3 days, and 0.1 mg/kg/day for 1 day), and 20 patients were in the control group. At similar mean airway pressure (MAP) and fractional inspired oxygen concentration (FiO2), respiratory system mechanics were measured before and on days 2, 5, and 7 of the study. Airway pressure, flow and tidal volume (V(T)) were recorded and only mechanical breaths were analyzed. Respiratory compliance (C(rs)) and respiratory resistance (R(rs)) were calculated by two factor least mean square analysis. Results. Eighty-three percent of infants in the dexamethasone group and 90% in the control group received surfactant in the first 24 hours of life. There was a significant increase in C(rs) and V(T) in the dexamethasone group as compared with the control group (P <.001). No major changes in R(rs) were observed. Dexamethasone therapy significantly decreased FiO2 and MAP P <.001) and facilitated successful weaning from mechanical ventilation. In addition to a shorter duration of mechanical ventilation (P <.01), the occurrence of CLD (FiO2 > 0.21 at 36 weeks of corrected gestational age, chest radiograph changes) was significantly decreased in the dexamethasone group (P <.01). Except for a transient increase in blood pressure and serum glucose, there were no significant differences in infection rates, intraventricular hemorrhage, or retinopathy of prematurity. Thirteen patients in the control group received dexamethasone at a later age. Conclusions. Our findings indicate that: 1) early dexamethasone therapy in VLBW infants markedly improves respiratory compliance and tidal volume, reduces FiO2 and MAP requirements, and facilitates extubation in these infants; 2) early dexamethasone therapy reduces the duration of mechanical ventilation and decreases CLD (at 28 days and 36 weeks) in a population of VLBW infants largely treated with surfactant.

KW - chronic lung disease

KW - dexamethasone therapy

KW - respiratory mechanics

KW - very low birth weight infants

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VL - 95

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JO - Pediatrics

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