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).