Early postnatal dexamethasone for the prevention of chronic lung disease in high-risk preterm infants

Objective: The purpose of this study was to evaluate the effect of early ad ministration of dexamethasone on the incidence of chronic lung disease (CLD ) in high risk preterm infants and to evaluate the side effects of the earl y steroid administration. Design: Randomised clinical trial. Setting: Neonatal intensive care unit. Patients: 50 infants at high risk of CLD were randomly assigned after 72 h of life to the dexamethasone group (n = 25) or to the control group (n = 25 ). The treated infants received dexamethasone intravenously from the 4th da y of life for 7 days (0.5 mg/kg per day for the first 3 days, 0.25 mg/kg pe r day for the next 3 days and 0.125 mg/kg per day on the 7th day). The cont rol group received no steroid treatment. Results: The incidence of CLD at 28 days of life and at 36 weeks' postconce ptional age was significantly lower in the dexamethasone group than in the control group (p < 0.001). Moreover, infants in the dexamethasone group rem ained intubated and required oxygen therapy for a shorter period than those in the control group (p < 0.001). Hyperglycaemia, hypertension, growth fai lure and mainly hypertrophy of the left ventricle were the transient side e ffects associated with early steroid administration. Conclusions: Early dexamethasone administration may be useful in preventing CLD, but its use should prudently be restricted to preterm infants at high risk of CLD.