Early versus late dexamethasone treatment in preterm infants at risk for chronic lung disease: a randomized pilot study

The purpose of this controlled, prospective pilot study was to compare the short-and long-term efficacy of early versus late treatment with dexamethas one (Dex) in preterm infants at risk for chronic lung disease (CLD). Thirty ventilated premature infants with a birth weight less than or equal to 125 0 g were randomized to receive Dex either from day 7 or from day 14. Dex wa s administered over 16 days tapering from 0.5 mg/kg per day to 0.1 mg/kg pe r day. The infants of the early treatment group could be weaned significant ly earlier from the ventilator - after 14 days (median; range 9-24) versus 24 days (median; range 8-44) in the late treatment group. The need for supp lemental oxygen was shorter if Dex was started early - 24 days (median; ran ge 10-57) versus 40 days (median; range 10-74). Oxygen dependency at 28 day s of age was similar between the groups - 6 out of 14 infants (42.9%) versu s 10 out of 16 patients (62.5%). The long-term efficacy of the two Dex regimens on lung function was evaluat ed by body plethysmographic measurements made at the age of 3 months. Thora cic gas volume and airway resistance were measured and specific airway cond uctance calculated. No statistically significant differences between the gr oups were demonstrated. Conclusion Early dexamethasone treatment led to earlier extubation in our s tudy population, but was not associated with significant advantages regardi ng oxygen dependency at 28 days of life and pulmonary function test at 3 mo nths of age.