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. [PubMed 16396863]