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Am J Perinatol 2024; 41(10): 1359-1365
DOI: 10.1055/a-1927-0619
Original Article

A Dose-Limited Dexamethasone and Bubble Continuous Positive Airway Pressure in Ventilation-Dependent Extremely Premature Infants

Mohamed A. Mohamed 
1   Newborn Services Division, the George Washington University Hospital, Washington, District of Columbia
2   Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
,
Aaron Bergman 
3   Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, Washington, District of Columbia
4   Department of Health, State of Maryland, Baltimore, Maryland
,
Dinan Abdelatif
1   Newborn Services Division, the George Washington University Hospital, Washington, District of Columbia
5   Department of Obstetrics and Gynecology, the George Washington University Hospital, Washington, District of Columbia
,
Beri Massa-Buck
1   Newborn Services Division, the George Washington University Hospital, Washington, District of Columbia
6   Division of Neonatology, Children's National Medical Center, Washington, District of Columbia
› Author Affiliations Funding None.
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Abstract

Objective Dexamethasone has been associated with early extubation and shorter duration of mechanical ventilation in preterm infants. High doses or prolonged courses of dexamethasone may be associated with poor neurodevelopmental outcomes.

Study Design This is an observational cohort study assessing the efficacy of a low-dose short dexamethasone course combined with postextubation bubble continuous positive airway pressure (bCPAP) strategy on rates of successful extubation and reduction of the duration of invasive mechanical ventilation in extremely preterm infants. We compared the short-term outcomes of implementing such strategy on a group of infants with birth weight <750 g to a historical cohort.

Results Among infants intubated for at least 10 days, median time to extubation from starting the dexamethasone course was 2 days (interquartile range: 1–3). Total duration of intubation was significantly shorter in infants who received dexamethasone compared with the control groups (21 ± 6 vs. 30 ± 10 days, p = 0.03), and although statistically nonsignificant, duration to wean to 21% bCPAP was shorter compared with the control group (48 ± 13 vs. 74 ± 29 days, p = 0.06).

Conclusion A low-dose short dexamethasone course combined with postextubation bCPAP intervention may be associated with successful early extubation and shorter duration of mechanical ventilation.

Key Points

  • Noninvasive strategies may not succeed in infants < 750 g birth weight.

  • Bubble CPAP has been shown to be associated with reduced complications including chronic lung disease.

  • Postnatal dexamethasone therapy may succeed in conjunction with bubble CPAP to reduce reintubation.

Keywords

dexamethasone - extremely premature infants - bubble continuous positive airway pressure - chronic lung disease

Table of Content Summary

Assessing the use of a dose-limited, short course of dexamethasone with bubble CPAP to reduce the duration of endotracheal intubation in ventilation-dependent extremely premature infants.




Publication History

Received: 09 March 2022

Accepted: 01 August 2022

Accepted Manuscript online:
18 August 2022

Article published online:
26 September 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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