Very Late (> 60 days) Rescue Dexamethasone for Chronic Lung Disease of Prematurity

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ESPR246
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Background: 10 day course of low dose dexamethasone (cumulative dose of 0.89 mg/kg) is commonly used to prevent and treat chronic lung disease (CLD) of prematurity. Most studies describe the use of dexamethasone in the first 1-2 months of life. The utility of dexamethasone in treating chronic lung disease of prematurity after the first two months of life is not well established. 

Design: This is a single center, retrospective chart review comparing the use of dexamethasone for prevention and treatment of chronic lung disease of prematurity, before and after 60 days of age (Early and Late groups). We looked at respiratory support, mean airway pressures (MAP) and fraction of inspired oxygen (FiO2) the start of therapy (Day 1), at the end of therapy (Day 10) and Day 21 after start of therapy, when off medication. A validated Pulmonary Severity Score was also calculated for each assessment point, using fraction of inspired oxygen, type of respiratory support and the use of medications to treat CLD. We also looked at the incidence of side effects – hypoglycemia, hyperglycemia, hypertension, gastro-intestinal bleeding, sepsis and inadequate weight gain (<15 grams/day) between the 2 groups.

Results: Table 1 and Figure show change in respiratory support over time for both groups. Overall, in both groups there was a trend towards a decrease in the percent of infants needing mechanical ventilation after treatment, with decreases in MAP and PSS, even on Day 21. Side effects are shown in Table 2 – more blood sugar abnormalities and hypertension in the early and late groups, respectively.

Conclusions: Using dexamethasone to treat chronic lung disease of prematurity after 60 days of life showed a trend towards de-escalation of respiratory support from invasive to non-invasive support, similar to earlier treatment. Many more infants in the Late group were on non-invasive support at the start of treatment.

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Sidney Kimmel Medical College at Thomas Jefferson University
Thomas Jefferson University Hospital
Christiana Care

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