A single very early dexamethasone dose improves respiratory and cardiovascular adaptation in preterm infants

Objectives: To test the hypothesis that a single dose of dexamethasone give n soon after delivery to infants <28 weeks' gestation leads to improved car diopulmonary adaptation in the first week and lowers the risk of significan t intraventricular hemorrhage. Methods: In a prospective, blinded, placebo-controlled study, we randomly a ssigned 70 infants <28 weeks' gestation who were born in the hospital to re ceive dexamethasone (0.2 mg/kg) (n = 37) or normal saline solution (n = 33) within 2 hours of delivery. After an interim analysis showed that the inci dence of intraventricular hemorrhage was much lower than expected, enrollme nt was stopped and we limited our analysis to a comparison of ventilator se ttings, blood pressure, and presser use during the first 7 days. Results: Clinical characteristics of the groups were comparable at study en try. Ventilator weaning occurred more rapidly in the patients who received dexamethasone: their intermittent mandatory ventilation rate was significan tly lower on days 1 through 6, and their peak inspiratory pressure was lowe r on days 3 through 7 compared with the control group. Mean blood pressures were higher in the dexamethasone group within 12 hours and remained higher through day 5, but the use of pressors was not different. Fewer infants in the dexamethasone group received indomethacin to treat a patent ductus art eriosus (22% vs 47%, P < .03). Conclusion: Dexamethasone given within 2 hours of delivery to preterm infan ts <28 weeks' gestation resulted in lower ventilator settings and higher me an blood pressures during the first 7 days. Fewer infants required indometh acin to treat a patent ductus arteriosus.