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Second course of systemic dexamethasone: efficacy and respiratory function changes

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Theodore Dassios, Ourania Kaltsogianni, Anne Greenough

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Background: There is a paucity of data concerning the efficacy of a second course of systemic postnatal corticosteroids resulting in a successful extubation of prematurely-born, ventilated infants and its effect on their respiratory function. Objectives: To determine the efficacy of a second course of systemic dexamethasone in successful extubation of prematurely-born infants and to describe the respiratory function changes that occur following the administration of the second course Methods: Retrospective cohort study of ventilated infants less than 30 weeks of gestation who received a nine-day second course of intravenous dexamethasone in a tertiary neonatal unit. Extubation was deemed successful if the infants were not re-intubated within 72 h of the extubation attempt. We calculated the ventilation perfusion ratio (VA/Q) and the fraction of required oxygen (FIO2) requirement expressed as a percentage before and after the course. Results: Fifteen (10 male) infants with a median (IQR) gestational age (GA) of 25.7 (24.7–26.6) weeks and a birth weight of 0.79 (0.67–0.93) kg were studied at a postnatal age of 60 (48–73) days. Fourteen of fifteen infants (93%) were successfully extubated. The VA/Q before the course was 0.13 (0.11–0.16) and significantly higher at 72 h after starting the course [0.26 (0.19–0.36), p = 0.001]. The FIO2 requirement decreased from 0.70 (0.59–0.79) to 0.34 (0.28–0.52) nine days after starting the course (p <.001). Conclusions: A second course of systemic dexamethasone appears efficient in weaning premature infants off invasive ventilation and is associated with a significant improvement in oxygenation.

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