DEXAMETHASONE USE IN BRONCHOPULMONARY DYSPLASIA

Dexamethasone has been shown to improve pulmonary function in some infants with bronchopulmonary dysplasia. The mechanisms of its action are not clear and the complications associated with its use are significant. The most important complication is infection. Still, for some infants, use of this agent may allow more rapid withdrawal of mechanical ventilatory support.

Infants eligible for dexamethasone include the following:

  1. Ventilator-dependent lung disease of two or more weeks duration;
  2. Requiring FiO2 > .30;
  3. Chest x-ray consistent with BPD;
  4. Insufficient clinical improvement during week prior to instituting dexamethasone, in spite of aggressive medical management. This includes continuous use of methylxanthines(theophylline or caffeine), diuretics, fluid restriction, intravenous nutrition, and medical or surgical ligation of the ductus arteriosus when indicated.

Dexamethasone is used for a relatively short period of time, not to exceed one month. A one week dosing schedule follows; abbreviated courses (4-7 days) using a rapid wean are also used at the attending's discretion. Side effects (glucose intolerance, hypertension, immune suppression) can be very pronounced in extreme prematurity; a starting dose of 0.3mg/kg/day may be used in smaller infants.

DEXAMETHASONE WEANING SCHEDULE

 Day of Dose

  Dose

 1

 0.5 mg/kg/day divided q 12hr

 2

 0.5 mg/kg/day divided q 12hr

3

 0.5 mg/kg/day divided q 12hr

4

 0.25 mg/kg/day divided q 12hr

5

 0.25 mg/kg/day divided q 12hr

6

 0.25 mg/kg/day divided q 12hr

7

 0.10 mg/kg single dose

Drug effects begin approximately 24 hours after institution of therapy. In two studies, patients have been extubated in approximately 6 ± 2 days. Therefore, when a decision to start dexamethasone is made, patients must be "pushed" in an effort to decrease mechanical support. This means frequent ventilator adjustment and patient assessment.

ADRENAL SUPPRESSION

If there is concern over possible adrenal suppression, AM serum cortisol and ACTH levels may be obtained once at least two weeks after steroids have been discontinued. If results are abnormal, stress doses of Solucortef should be used for surgical procedures or acute illness. Stress dose may also be given empirically at the attendings discretion if an infant has received recent doses of steroids or a prolonged course(s) of steroids. Give as follows:

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