Respiratory and systemic effects of inhaled dexamethasone on ventilator dependant preterm infants at risk for bronchopulmonary dysplasia
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Short term inhaled dexamethasone therapy was evaluated in a double blind placebo controlled trial in 36 ventilator dependent preterm neonates (BW<1500 gm, postnatal age>7 days) who were at risk for bronchopulmonary dysplasia. Pulmonary and systemic effects were compared at early (day 3), late (7–10 days) and post (14 days after initiation) phases of therapy. Airflow mechanics improved as demonstrated by a net 101% improvement in pulmonary resistance (a decrease from 139 to 101 cm H2O/L/s in the dexamethasone treated infants as compared to an increase from 153 to 267 cm H2O/L/s in the placebo treated infants during the early phase of therapy); this was associated with a 45% increase in inspiratory airflow (1.29±0.43 to 1.87±0.978 L/min; p<0.01), and 37% increase in expiratory airflow. These changes resulted in a significant reduction in the work of breathing such that the mean tidal driving pressure significantly decreased from 13.6 cmH2O to 9.4 cm H2O with inhaled steroid administration. Though the brief duration of therapy did not result in cessation of ventilatory support, the level of support was significantly reduced (decreased values of oxygen supplementation, mean airway pressure and oxygenation index and increased ventilatory efficiency index). The inhaled dexamethasone therapy was also associated with systemic absorption of the drug as evidenced by transient but apparently reversible reduction in serum cortisol levels. No systemic side effects of hypertension, hyperglycemia or nosocomial sepsis were observed. These data demonstrate beneficial effects of short term inhaled dexamethasone on the resistive airflow properties of preterm infants at risk for BPD and may provide adjunctive means to facilitate weaning in the ventilator dependent neonates.
Key wordsInhalation Dexamethasone Bronchopulmonary dysplasia
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- 3.Collaborative Dexamethasone Trial Group. Dexamethasone therapy in neonatal chronic lung disease: An international placebo-controlled trial.Pediatrics 1991; 88: 421–427.Google Scholar
- 11.Pappagallo M, Blondheim O, Bhutani VK, Abbasi S. Effect of inhaled dexamethasone in ventilator dependent preterm infants.Pediatr Res 1990; 27: 219A.Google Scholar
- 13.Williams TJ, Yarwood H. Effect of glucocorticosteroids on microvascular permeability.Am Rev Respir Dis 1990; 141: S39–43.Google Scholar
- 17.Abbasi S, Silva W, Gerdes JS, Bhutani VK. Role of dexamethasone therapy for severe tracheobronchial mucosal lesions in mechanically ventilated preterm infants.Ped Res 1993; 33: 198A.Google Scholar