Prediction of individual response to postnatal dexamethasone in ventilator dependent preterm infants
a Department of Neonatal Medicine, Royal Prince Alfred
Hospital and University of Sydney, Missenden Road, Camperdown, NSW
2050, Australia, b Department
of Medical Imaging, Royal Alexandra Hospital for Children, Sydney, NSW,
Australia
Correspondence to: Dr Nick Evans.nevans{at}med.usyd.edu.au
Accepted 6 November 1997
AIMS
To evaluate factors predictive of individual
response to dexamethasone in preterm infants.
METHODSA cohort of 74 preterm infants born
between January 1993 and February 1996 was studied retrospectively. All
of them had received dexamethasone to facilitate weaning from
artificial ventilation. Demographic factors, ventilation parameters,
and details of dexamethasone administration were recorded from the
medical and nursing notes. Radiographs were assessed by one observer
who was unaware of the clinical condition of the infant or the outcome.
Outcome variables examined included change in ventilation index (VI) at
36-48 hours, the number of days to extubation from the start of
dexamethasone, and death before extubation.
RESULTSMost babies improved but changes in VI at
36-48 hours ranged from substantial deterioration to dramatic
improvement. No identifiable factors were significantly associated with
this range of response. The median time to extubation was 6 days. The
36 babies who extubated within the first 6 days were: significantly
more mature; less likely to have pulmonary interstitial emphysema (PIE)
or pneumothorax; and had significantly lower VIs in the 12 hours
preceding dexamethasone treatment. The postconceptional age at
extubation was the same whether babies were extubated within or after
the first 6 days. Multiple linear regression confirmed a significant
association between number of days to extubation and the three factors
described above (adjusted R2=0.5126).
CONCLUSIONSIndividual responses to dexamethasone
can be partly predicted by gestation, the presence of PIE, and the VI
before dexamethasone administration.
© 1998 by Archives of Disease in Childhood
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