Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: A multicenter, international, randomized, controlled trial

Lex W. Doyle; Peter G. Davis; Colin J. Morley; Andy McPhee; John B. Carlin; M. Kaimakamis; C. Callanan; V. Yu; M. Hayes; R. Li; S. Fraser; A. Gill; R. Lontis; L. Goodchild; N. French; N. Evans; S. Reid; B. Darlow; C. Kuschel; R. Alvaro; A. Chiu; K. Sankaran; K. Jamsen; J. Hiller; J. Lumley; J. C. Sinclair

doi:10.1542/peds.2004-2843

Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: A multicenter, international, randomized, controlled trial

Lex W. Doyle, Peter G. Davis, Colin J. Morley, Andy McPhee, John B. Carlin, M. Kaimakamis, C. Callanan, V. Yu, M. Hayes, R. Li, S. Fraser, A. Gill, R. Lontis, L. Goodchild, N. French, N. Evans, S. Reid, B. Darlow, C. Kuschel, R. AlvaroA. Chiu, K. Sankaran, K. Jamsen, J. Hiller, J. Lumley, J. C. Sinclair

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Abstract

OBJECTIVE. Postnatal corticosteroid therapy is controversial. The aim of this study was to determine the short-term effects of low-dose dexamethasone treatment among chronically ventilator-dependent neonates. METHODS. Very preterm (gestational age: <28 weeks) or extremely low birth weight (birth weight: <1000 g) infants who were ventilator dependent after the first 1 week of life were eligible and were assigned randomly to receive masked dexamethasone (0.89 mg/kg over 10 days) or saline placebo. Data on ventilator and oxygen requirements and deaths were recorded. RESULTS. Seventy infants were recruited from 11 centers, at a median age of 23 days. More infants were extubated successfully by 10 days of treatment in the dexamethasone group (60%, 21 of 35 patients) than in the control group (12%, 4 of 34 patients) (odds ratio [OR]: 11.2; 95% confidence interval [CI]: 3.2-39.0). Ventilator and oxygen requirements improved substantially, and the duration of intubation was shorter. There was little evidence for a reduction in either the mortality rate (dexamethasone group: 11%; control group: 20%; OR: 0.52; 95% CI: 0.14-1.95) or the rate of oxygen dependence at 36 weeks (dexamethasone group: 85%; control group: 91%; OR: 0.58; 95% CI: 0.13-2.66). There were no obvious effects of low-dose dexamethasone on blood glucose concentrations, blood pressure, or other complications. No infant experienced intestinal perforation. CONCLUSIONS. Low-dose dexamethasone treatment after the first 1 week of life clearly facilitates extubation and shortens the duration of intubation among ventilator-dependent, very preterm/extremely low birth weight infants, without any obvious short-term complications. Combined with recent evidence that infants at very high risk of bronchopulmonary dysplasia may benefit in the long term, our study reopens debate regarding the role of low-dose, late postnatal, corticosteroid therapy.

Original language	English
Pages (from-to)	75-83
Number of pages	9
Journal	Pediatrics
Volume	117
Issue number	1
DOIs	https://doi.org/10.1542/peds.2004-2843
Publication status	Published or Issued - Jan 2006

Keywords

Bronchopulmonary dysplasia
Extubation
Infant
Low birth weight
Low-dose dexamethasone
Preterm

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

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Doyle, L. W., Davis, P. G., Morley, C. J., McPhee, A., Carlin, J. B., Kaimakamis, M., Callanan, C., Yu, V., Hayes, M., Li, R., Fraser, S., Gill, A., Lontis, R., Goodchild, L., French, N., Evans, N., Reid, S., Darlow, B., Kuschel, C., ... Sinclair, J. C. (2006). Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: A multicenter, international, randomized, controlled trial. Pediatrics, 117(1), 75-83. https://doi.org/10.1542/peds.2004-2843

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title = "Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: A multicenter, international, randomized, controlled trial",

abstract = "OBJECTIVE. Postnatal corticosteroid therapy is controversial. The aim of this study was to determine the short-term effects of low-dose dexamethasone treatment among chronically ventilator-dependent neonates. METHODS. Very preterm (gestational age: <28 weeks) or extremely low birth weight (birth weight: <1000 g) infants who were ventilator dependent after the first 1 week of life were eligible and were assigned randomly to receive masked dexamethasone (0.89 mg/kg over 10 days) or saline placebo. Data on ventilator and oxygen requirements and deaths were recorded. RESULTS. Seventy infants were recruited from 11 centers, at a median age of 23 days. More infants were extubated successfully by 10 days of treatment in the dexamethasone group (60%, 21 of 35 patients) than in the control group (12%, 4 of 34 patients) (odds ratio [OR]: 11.2; 95% confidence interval [CI]: 3.2-39.0). Ventilator and oxygen requirements improved substantially, and the duration of intubation was shorter. There was little evidence for a reduction in either the mortality rate (dexamethasone group: 11%; control group: 20%; OR: 0.52; 95% CI: 0.14-1.95) or the rate of oxygen dependence at 36 weeks (dexamethasone group: 85%; control group: 91%; OR: 0.58; 95% CI: 0.13-2.66). There were no obvious effects of low-dose dexamethasone on blood glucose concentrations, blood pressure, or other complications. No infant experienced intestinal perforation. CONCLUSIONS. Low-dose dexamethasone treatment after the first 1 week of life clearly facilitates extubation and shortens the duration of intubation among ventilator-dependent, very preterm/extremely low birth weight infants, without any obvious short-term complications. Combined with recent evidence that infants at very high risk of bronchopulmonary dysplasia may benefit in the long term, our study reopens debate regarding the role of low-dose, late postnatal, corticosteroid therapy.",

keywords = "Bronchopulmonary dysplasia, Extubation, Infant, Low birth weight, Low-dose dexamethasone, Preterm",

author = "Doyle, {Lex W.} and Davis, {Peter G.} and Morley, {Colin J.} and Andy McPhee and Carlin, {John B.} and M. Kaimakamis and C. Callanan and V. Yu and M. Hayes and R. Li and S. Fraser and A. Gill and R. Lontis and L. Goodchild and N. French and N. Evans and S. Reid and B. Darlow and C. Kuschel and R. Alvaro and A. Chiu and K. Sankaran and K. Jamsen and J. Hiller and J. Lumley and Sinclair, {J. C.}",

year = "2006",

month = jan,

doi = "10.1542/peds.2004-2843",

language = "English",

volume = "117",

pages = "75--83",

journal = "Pediatrics",

issn = "0031-4005",

publisher = "American Academy of Pediatrics",

number = "1",

}

Doyle, LW, Davis, PG, Morley, CJ, McPhee, A, Carlin, JB, Kaimakamis, M, Callanan, C, Yu, V, Hayes, M, Li, R, Fraser, S, Gill, A, Lontis, R, Goodchild, L, French, N, Evans, N, Reid, S, Darlow, B, Kuschel, C, Alvaro, R, Chiu, A, Sankaran, K, Jamsen, K, Hiller, J, Lumley, J & Sinclair, JC 2006, 'Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: A multicenter, international, randomized, controlled trial', Pediatrics, vol. 117, no. 1, pp. 75-83. https://doi.org/10.1542/peds.2004-2843

TY - JOUR

T1 - Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants

T2 - A multicenter, international, randomized, controlled trial

AU - Doyle, Lex W.

AU - Davis, Peter G.

AU - Morley, Colin J.

AU - McPhee, Andy

AU - Carlin, John B.

AU - Kaimakamis, M.

AU - Callanan, C.

AU - Yu, V.

AU - Hayes, M.

AU - Li, R.

AU - Fraser, S.

AU - Gill, A.

AU - Lontis, R.

AU - Goodchild, L.

AU - French, N.

AU - Evans, N.

AU - Reid, S.

AU - Darlow, B.

AU - Kuschel, C.

AU - Alvaro, R.

AU - Chiu, A.

AU - Sankaran, K.

AU - Jamsen, K.

AU - Hiller, J.

AU - Lumley, J.

AU - Sinclair, J. C.

PY - 2006/1

Y1 - 2006/1

N2 - OBJECTIVE. Postnatal corticosteroid therapy is controversial. The aim of this study was to determine the short-term effects of low-dose dexamethasone treatment among chronically ventilator-dependent neonates. METHODS. Very preterm (gestational age: <28 weeks) or extremely low birth weight (birth weight: <1000 g) infants who were ventilator dependent after the first 1 week of life were eligible and were assigned randomly to receive masked dexamethasone (0.89 mg/kg over 10 days) or saline placebo. Data on ventilator and oxygen requirements and deaths were recorded. RESULTS. Seventy infants were recruited from 11 centers, at a median age of 23 days. More infants were extubated successfully by 10 days of treatment in the dexamethasone group (60%, 21 of 35 patients) than in the control group (12%, 4 of 34 patients) (odds ratio [OR]: 11.2; 95% confidence interval [CI]: 3.2-39.0). Ventilator and oxygen requirements improved substantially, and the duration of intubation was shorter. There was little evidence for a reduction in either the mortality rate (dexamethasone group: 11%; control group: 20%; OR: 0.52; 95% CI: 0.14-1.95) or the rate of oxygen dependence at 36 weeks (dexamethasone group: 85%; control group: 91%; OR: 0.58; 95% CI: 0.13-2.66). There were no obvious effects of low-dose dexamethasone on blood glucose concentrations, blood pressure, or other complications. No infant experienced intestinal perforation. CONCLUSIONS. Low-dose dexamethasone treatment after the first 1 week of life clearly facilitates extubation and shortens the duration of intubation among ventilator-dependent, very preterm/extremely low birth weight infants, without any obvious short-term complications. Combined with recent evidence that infants at very high risk of bronchopulmonary dysplasia may benefit in the long term, our study reopens debate regarding the role of low-dose, late postnatal, corticosteroid therapy.

AB - OBJECTIVE. Postnatal corticosteroid therapy is controversial. The aim of this study was to determine the short-term effects of low-dose dexamethasone treatment among chronically ventilator-dependent neonates. METHODS. Very preterm (gestational age: <28 weeks) or extremely low birth weight (birth weight: <1000 g) infants who were ventilator dependent after the first 1 week of life were eligible and were assigned randomly to receive masked dexamethasone (0.89 mg/kg over 10 days) or saline placebo. Data on ventilator and oxygen requirements and deaths were recorded. RESULTS. Seventy infants were recruited from 11 centers, at a median age of 23 days. More infants were extubated successfully by 10 days of treatment in the dexamethasone group (60%, 21 of 35 patients) than in the control group (12%, 4 of 34 patients) (odds ratio [OR]: 11.2; 95% confidence interval [CI]: 3.2-39.0). Ventilator and oxygen requirements improved substantially, and the duration of intubation was shorter. There was little evidence for a reduction in either the mortality rate (dexamethasone group: 11%; control group: 20%; OR: 0.52; 95% CI: 0.14-1.95) or the rate of oxygen dependence at 36 weeks (dexamethasone group: 85%; control group: 91%; OR: 0.58; 95% CI: 0.13-2.66). There were no obvious effects of low-dose dexamethasone on blood glucose concentrations, blood pressure, or other complications. No infant experienced intestinal perforation. CONCLUSIONS. Low-dose dexamethasone treatment after the first 1 week of life clearly facilitates extubation and shortens the duration of intubation among ventilator-dependent, very preterm/extremely low birth weight infants, without any obvious short-term complications. Combined with recent evidence that infants at very high risk of bronchopulmonary dysplasia may benefit in the long term, our study reopens debate regarding the role of low-dose, late postnatal, corticosteroid therapy.

KW - Bronchopulmonary dysplasia

KW - Extubation

KW - Infant

KW - Low birth weight

KW - Low-dose dexamethasone

KW - Preterm

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U2 - 10.1542/peds.2004-2843

DO - 10.1542/peds.2004-2843

M3 - Article

C2 - 16396863

AN - SCOPUS:33644833407

SN - 0031-4005

VL - 117

SP - 75

EP - 83

JO - Pediatrics

JF - Pediatrics

IS - 1

ER -

Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: A multicenter, international, randomized, controlled trial

Abstract

Keywords

ASJC Scopus subject areas

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