Airway edema or extubation: Limited data available: IV: 0.25 mg/kg/dose given ~4 hours prior to scheduled extubation then every 8 hours for a total of 3 doses (Couser 1992); others have used 0.5 mg/kg/dose every 8 hours for 3 doses with last dose administered 1 hour prior to scheduled extubation (Davis 2001); range: 0.25 to 0.5 mg/kg/dose for 1 to 3 doses; maximum daily dose: 1.5 mg/kg/day. Note: A longer duration of therapy may be needed with more severe cases. A recent meta-analysis concluded that future neonatal clinical trials should study a multiple dose strategy with initiation of dexamethasone at least 12 hours before extubation (Khemani 2009).
Bronchopulmonary dysplasia, facilitation of ventilator wean: Limited data available: PNA ≥7 days: Oral, IV: Initial: 0.15 mg/kg/day in divided doses every 12 hours for 3 days, followed by a taper of: 0.1 mg/kg/day for 3 days, then 0.05 mg/kg/day for 2 days, and 0.02 mg/kg/day for 2 days for a total dexamethasone dose of 0.89 mg/kg given over 10 days; tapering doses were administered in divided doses every 12 hours (Doyle 2006). Note: Multiple regimens have been described. Optimal regimen has not been defined. High doses (~0.5 mg/kg/day) are associated with higher incidence of adverse effects (including adverse neurodevelopmental outcomes) and are not recommended for use (Watterberg 2010). However, a meta-analysis reported total cumulative doses >4 mg/kg initiated after the first week of life produced a greater reduction in the relative risk compared to lower cumulative doses for the combined outcome, mortality, or bronchopulmonary dysplasia without increasing the risk of neurodevelopmental sequelae in ventilated preterm infants (Onland 2009).
DART trial protocol: 0.075 mg/kg/dose every 12 hours for 3 days, 0.05 mg/kg/dose every 12 hours for 3 days, 0.025 mg/kg/dose every 12 hours for 2 days, and 0.01 mg/kg/dose every 12 hours for 2 days [1] . Doses may be administered IV slow push or orally.
Dexamethasone is the most studied systemic corticosteroid in BPD prevention. The dosing protocol from DART (Dexamethasone: A Randomized Trial) is widely utilized in NICUs across the United States.28
Dexamethasone is administered IV slow push or
orally as follows: 0.075 mg/kg/dose every 12 hours for 3 days; 0.05 mg/kg/dose every 12 hours for 3 days; 0.025 mg/kg/dose every 12 hours for 2 days; and 0.01 mg/kg/dose every 12 hours for 2 days. The use of low-dose dexamethasone should be restricted to patients with the highest risk for developing BPD. Because early treatment was associated with cerebral palsy and neurodevelopmental impairment, treatment should be started after 7 days of life. Due to the increased risk for GI perforation, dexamethasone should not be used concurrently with indomethacin. Blood glucose and blood pressure should be monitored in patients receiving dexamethasone. If treatment lasts longer than 7 days, an echocardiogram isRespiratory Distress Syndrome and Bronchopulmonary Dysplasia 89
recommended as cardiac changes have been reported with prolonged use of dexamethasone. The use of dexamethasone is contraindicated in patients with systemic infection.27-29
Ref: Nicu primer for pharmacist
Micromedex Neofax,
Couser RJ, Ferrara TB, Falde B, et al. Effectiveness of dexamethasone in preventing extubation failure in preterm infants at increased risk for airway edema. J Pediatr. 1992;121(4):591-596. [PubMed 1403397],
Doyle LW, Davis PG, Morley CJ, et al. Low-Dose Dexamethasone Facilitates Extubation Among Chronically Ventilator-Dependent Infants: A Multicenter, International, Randomized, Controlled Trial. Pediatrics. 2006;117(1):75-83. [PubMe
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