Prevention of chronic lung disease in preterm infants by early postnatal dexamethasone therapy

Recent studies suggest that early dexamethasone therapy may lessen the pulm onary inflammation in preterm infants with respiratory distress syndrome (R DS). To investigate whether early (<12 hr) postnatal dexamethasone therapy would reduce the incidence of chronic lung disease (CLD), a randomized, dou ble-blind, controlled trial was conducted in 40 infants (birth weights from 500 to 1,999 gm) who had severe RDS and required mechanical ventilation wi thin 6 hr of birth. All infants received one dose of Survanta(R) before the y were randomly assigned to control (saline placebo) or dexamethasone-treat ed groups (0.5 mg/kg/d for 1 week, then tapered over 3 weeks). Sequential a nalysis was performed with the end point of assessment being the presence o r absence of CLD on postnatal Day 28. Statistical significance favoring dexamethasone was reached when 12 consecu tive pairs in which one infant had CLD and the other did not have CLD showe d that ten pairs favored dexamethasone and two pairs favored control treatm ent. Among the survivors, 12/15 were extubated in the dexamethasone group a nd 9/16 in the control group at the end of study. Infants in the treated gr oup had transient hyperglycemia and hypertension. There was no difference b etween the groups in mortality and in incidence of sepsis or intraventricul ar hemorrhage. We conclude that early postnatal dexamethasone therapy is po tentially effective in the lessening of CLD in preterm infants. To substant iate our result, large randomized controlled trials are needed and warrante d. Pediatr Pulmonol, 1999; 27:21-26, (C) 1999 Wiley-Liss, Inc.