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Dexamethasone therapy for bronchopulmonary dysplasia: Improved respiratory mechanics without adrenal suppression
Author(s) -
Brundage K. L.,
Mohsini K. G.,
Froese A. B.,
Walker C. R.,
Fisher J. T.
Publication year - 1992
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.1950120307
Subject(s) - medicine , bronchopulmonary dysplasia , dexamethasone , anesthesia , corticosteroid , respiratory physiology , dose , respiratory system , gestational age , pregnancy , genetics , biology
The purpose of the present study was to examine the pattern of changes in respiratory system mechanics induced by dexamethasone (Dex) in infants with bronchopulmonary dysplasia (BPD) and to determine whether dosages that produce these changes induce adrenal suppression. We examined mechanics in seven ventilator‐dependent premature infants (age, 33 ± 4.8 days) with BPD, before and daily during Dex therapy. Dex (0.5 mg/kg/day) was given intravenously for 7 days unless complications necessitated early termination. Respiratory system resistance (Rrs) and compliance (Crs) were measured by the passive expiratory flow‐volume technique during the course of dexamethasone therapy or until extubation. Adrenocorticotrophic hormone (ACTH) stimulation tests were done at baseline and following Dex therapy to evaluate adrenal function. Dex therapy caused a 77 ± 18% increase in Crs (from 0.97 ± 0.09 SEM mL/cmH 2 O to 1.6 ± 0.16 mL/cmH 2 O; P < 0.025) and a 33 ± 5% decrease in Rrs (from 0.20 ± 0.02 cmH 2 O/mL/s to 0.14 ± 0.01 cmH 2 O/mL/s P < 0.01). Concurrently, ventilator rate, mean airway pressure, and FI O 2all decreased significantly ( P < 0.025). Extubation occurred later in infants with the lowest Crs and highest Rrs at baseline. At extubation, all Crs values were greater than 1.33 mL/cmH 2 O and Rrs values were less than 0.15 cmH 2 O/mL/s. Systolic blood pressure increased from 61 ± 6.3 mmHg to 84 ± 17 mmHg, 72–96 h after the start of Dex ( P < 0.025). There were no episodes of culture‐positive sepsis. Neither basal nor ACTH‐stimulated levels of cortisol were suppressed as a result of Dex therapy ( P > 0.05). We conclude that correction of abnormalities of compliance is critical to reducing work of breathing and achieving extubation in this population. In the small number of infants we studied, Dex induced this therapeutic response with minimal side effects and no statistically significant change in adrenal function.