Neonatal Med.  2020 May;27(2):73-81. 10.5385/nm.2020.27.2.73.

Factors Associated with Clinical Response to Low-Dose Dexamethasone Therapy for Bronchopulmonary Dysplasia in Very Low Birth Weight Infants

• Shin J
• Kim SH
• Jung YH
• Choi CW
• Kim BI

• KMID: 2503162
• DOI: http://doi.org/10.5385/nm.2020.27.2.73

Abstract

Purpose
To identify factors associated with the clinical response to low-dose dexamethasone therapy (LDDT) in preterm infants for bronchopulmonary dysplasia (BPD).
Methods
We used a retrospective medical record review to evaluate preterm infants who were born before 32 weeks of gestation or with a birth weight less than 1,500 g. All infants were admitted to the neonatal intensive care unit at a tertiary academic hospital between January 2010 and June 2019, and received LDDT for BPD. The preterm infants’ respiratory severity scores (RSS) were calculated from the first day of LDDT to the day of extubation, or the last day of LDDT. A good response was defined as a decreasing RSS with a slope greater than 0.181. A poor response was defined as a non-decreasing RSS, or a decreasing RSS with a slope less than 0.181 during LDDT. A total dose of 1.1 mg/kg was administered for 10 days for each single course of LDDT.
Results
A total of 51 preterm infants were included in the final analysis. Thirty preterm infants (58.8 %) were in the good response group, and 21 preterm infants (41.2%) were in the poor response group. There were no significant differences in gestational age, birth weight, and sex between the good response group and poor response group. Preterm premature rupture of membrane and histologic chorioamnionitis were significantly associated with a poor response to LDDT. Higher RSS on the first day of the LDDT was associated with a good response to LDDT.
Conclusion
Antenatal infection and/or inflammation may be associated with an unfavorable response to postnatal LDDT for BPD. Preterm infants with more severe respiratory failure seem to benefit more from LDDT for BPD.

Keyword

Bronchopulmonary dysplasia; Dexamethasone; Premature

Figure

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  Figure 1. Flow chart of the study population. A total of 51 preterm infants were included in the analysis. Thirty infants (58.8%) were extubated successfully during the low-dose dexamethasone therapy, while 21 infants (41.2%) failed to be extubated. Thirty infants (58.8%) showed a good response to the low-dose dexamethasone therapy. The other 21 infants (41.2%) showed a poor response to therapy. All included infants developed moderate or severe bronchopulmonary dysplasia (BPD) on postmenstrual age (PMA) 36 weeks. Abbreviations: GA, gestational age; TTTS, twin to twin transfusion syndrome.

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  Figure 2. (A) The number of infants intubated during the low-dose dexamethasone therapy. The total number of intubated infants decreased rapidly until day 6 (at a rate of 5 to 6 infants/day) and then slowed down. In the poor response group, the total number of intubated infants decreased more slowly than in the good response group, and more infants remained intubated on the final day of low-dose dexamethasone therapy. (B) Changes in respiratory severity score (RSS) during the low-dose dexamethasone therapy. RSS rapidly decreased until day 5. However, RSS was high from day 6. Infants who remained intubated and showed a poor response until the end of the low-dose dexamethasone therapy needed additional respiratory support. The good response group showed a higher initial RSS than did the poor response group. However, compared to that in the poor response group, RSS in the good response group decreased rapidly until day 5.

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