361 - Contemporary Practice of Dexamethasone to Facilitate Extubation in Extremely Premature Infants and Effectiveness of Repeated Courses of Dexamethasone

Poster Number: 361
Publication Number: 361.440

Rajesh Pandey, McGovern Medical School at the University of Texas Health Science Center at Houston, Pearland, TX, United States; Wen Li, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Christine Domonoske, Children's Memorial Hermann Hospital, Houston, TX, United States

Background: Dexamethasone effectively decreases chronic lung disease (CLD) in premature infants. There are variations in the usage of dexamethasone, both with patient selection and the timing of administration. There are limited publications on the contemporary use of dexamethasone to facilitate extubation.

Objective: To study the effectiveness of the first and the second course of Dexamethasone and to identify predictors of successful extubation after Dexamethasone.

Design/Methods: This is an IRB-approved cohort study of extremely premature newborns (23 0/7 to 27 6/7 weeks gestational age) born between January 2015 to December 2018. Medical records were reviewed to extract the data. Dexamethasone is not used to facilitate extubation before 14 days of life in our institution, s therefore, infants requiring mechanical ventilation for less than 14 days of life were excluded. Eligible infants were categorized based on dexamethasone exposure to facilitate extubation. Infants who received dexamethasone were grouped into whether they received one, two , or more than two courses. Dexamethasone therapy was defined as a success if the infant was extubated during or within seven days of the dexamethasone course and remained extubated (unless intubated for an elective procedure) for at least two weeks.

Results: 170/340 (50%) remained intubated for more than 14 days. Sixty-seven of 170 infants (~ 40 %) received at least one course, 20 infants received two courses, and seven infants received more than two courses of dexamethasone. Table 1 shows baseline demographic and clinical characteristics of the infants after the first and the second course of dexamethasone. History of maternal hypertension and low 1 min APGAR were associated with higher failures. 

As expected, all infants who required dexamethasone for extubation had high ventilation days and prolonged lengths of stay. Those outcomes including a higher mortality rate were significantly worse in the group that failed to extubate. 

Table 2 shows the success of dexamethasone for extubation is comparable after the first and second course of Dexamethasone but was not after the third or the fourth course. There was no association between the timing of dexamethasone and treatment success on logistic regression.Conclusion(s): There was no difference in the effectiveness of dexamethasone success between the first and the second course. None of the infants who received >2 courses of dexamethasone were extubated. Maternal hypertension was inversely associated with success, while age at receiving dexamethasone was not significant after controlling for other factors.
Table 2 – Success of Infants receiving dexamethasone
Table 1 – – Characteristics of infants receiving dexamethasone