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Observational Study
. 2017 Apr:183:26-30.e3.
doi: 10.1016/j.jpeds.2016.12.035. Epub 2017 Jan 18.

Respiratory Support for Very Low Birth Weight Infants Receiving Dexamethasone

Yamini V Virkud  1 , Christoph P Hornik  2 , Daniel K Benjamin  3 , Matthew M Laughon  4 , Reese H Clark  5 , Rachel G Greenberg  2 , P Brian Smith  6
Affiliations
Observational Study

Respiratory Support for Very Low Birth Weight Infants Receiving Dexamethasone

Yamini V Virkud et al. J Pediatr. 2017 Apr.

Abstract

Objective: To assess how neonatal intensive care units followed the American Academy of Pediatrics guidelines for use of dexamethasone in preterm infants by evaluating respiratory support at the time of dexamethasone administration.

Study design: This is an observational study of infants discharged from one of 290 neonatal intensive care units from 2003 to 2010. The cohort included very low birth weight (<1500 g birth weight) infants born at ≤32 weeks gestational age. The main outcome was respiratory support at time of exposure to dexamethasone. Significant respiratory support was defined as invasive respiratory support (conventional or high-frequency ventilation) with a fraction of inspired oxygen (FiO2) > 0.3.

Results: Of 81 292 infants; 7093 (9%) received dexamethasone. At the time that dexamethasone was initiated, 4604 (65%) of infants were on significant respiratory support.

Conclusions: In accordance with the American Academy of Pediatrics recommendations, a majority of infants were on significant respiratory support when receiving dexamethasone, yet a substantial number of infants still received dexamethasone on less than significant respiratory support. Further research on reducing dexamethasone use in premature infants is required to decrease the risk of neurodevelopmental impairment.

Keywords: bronchopulmonary dysplasia; chronic lung disease; dexamethasone; very low birth weight.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(online): Flow diagram of the number of infants and number of sites analyzed. VLBW=very low birth weight (<1500g). GA=gestational age
Figure 2
Figure 2
Predicted risk of BPD or death for infants receiving dexamethasone. Dotted line represents the 50% cut-off above which the potential risks of steroid administration outweighed the likely benefits.(12)
Figure 3
Figure 3
Percentage of infants receiving significant support during time of dexamethasone administration by site. Only sites with 10 or more infants receiving dexamethasone were included.
Figure 4
Figure 4
(online): Percentage of infants receiving dexamethasone by site
See this image and copyright information in PMC

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