Comparing low-dose (DART) and enhanced low-dose dexamethasone regimens in preterm infants with bronchopulmonary dysplasia
IntroductionDetermining the optimal dexamethasone dosage for facilitating extubation in extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) remains uncertain. This study aims to compare the effectiveness of low-dose (DART) and enhanced low-dose dexamethasone regimens in a...
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| Language: | English |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2023.1261316/full |
| _version_ | 1827778164080771072 |
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| author | Heba Mohamed Al-taweel Ismail Sabry Ismail Abdelhady Nasreen Irfan Fadi Al Khzzam Abdullah Kamal Sudheer Babu Kurunthattil Thazhe Mohammad A. A. Bayoumi Ashraf Gad Ashraf Gad |
| author_facet | Heba Mohamed Al-taweel Ismail Sabry Ismail Abdelhady Nasreen Irfan Fadi Al Khzzam Abdullah Kamal Sudheer Babu Kurunthattil Thazhe Mohammad A. A. Bayoumi Ashraf Gad Ashraf Gad |
| author_sort | Heba Mohamed Al-taweel |
| collection | DOAJ |
| description | IntroductionDetermining the optimal dexamethasone dosage for facilitating extubation in extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) remains uncertain. This study aims to compare the effectiveness of low-dose (DART) and enhanced low-dose dexamethasone regimens in achieving successful extubation in these infants.MethodsWe conducted a retrospective cohort study at the Women's Wellness and Research Center (WWRC) involving ELBW infants who received dexamethasone for BPD prevention or treatment, or for extubation between January 1st, 2015, and December 31st, 2019. Our goal was to assess successful extubation within various time points of treatement.ResultsA total of 77 patients, matched in gestational age and BW, were enrolled in the study, receiving a total of 121 dexamethasone courses. Low-dose dexamethasone courses were administered 75 times to 49 infants, while 46 courses of enhanced low-dose were given to 28 infants. Treatment commenced at 30.8 ± 3.4 weeks post-menstrual age, compared to 32.1 ± 2.5 weeks in the enhanced low-dose group (p = 0.014). The median (IQR) course duration was seven (3–10) days in the low-dose group, while it was 10 (8–14) days in the enhanced low-dose group (p < 0.001). The median (IQR) course dose was 0.73 (0.53–0.86) mg/kg in the low-dose group and 1.27 (0.97–2.05) mg/kg in the enhanced low-dose group (p < 0.001). There were no differences in extubation success at any time point between the two groups at 72 h and seven days after treatment initiation, by course completion, and within seven days after treatment completion. However, regression analysis identified several predictors of successful extubation; baseline FiO2, course duration, and duration of invasive mechanical ventilation were negatively associated with successful extubation at various time points, while received dose per kg and cumulative dose positively correlated with successful extubation at different time points. No significant differences were observed in secondary outcomes, including death or BPD.ConclusionThe choice between low-dose and enhanced low-dose dexamethasone regimens may not significantly impact extubation success. However, careful consideration of dosing, ventilation status, and treatment duration remains crucial in achieving successful extubation. This study highlights the need for personalized dexamethasone therapy in ELBW infants. |
| first_indexed | 2024-03-11T14:29:18Z |
| format | Article |
| id | doaj.art-8e51de594e5643e2a802a00826f47b21 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-03-11T14:29:18Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-8e51de594e5643e2a802a00826f47b212023-10-31T11:28:35ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602023-10-011110.3389/fped.2023.12613161261316Comparing low-dose (DART) and enhanced low-dose dexamethasone regimens in preterm infants with bronchopulmonary dysplasiaHeba Mohamed Al-taweel0Ismail Sabry Ismail Abdelhady1Nasreen Irfan2Fadi Al Khzzam3Abdullah Kamal4Sudheer Babu Kurunthattil Thazhe5Mohammad A. A. Bayoumi6Ashraf Gad7Ashraf Gad8Pharmacy Department, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, QatarNeonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, QatarPediatric Department, Children’s Hospital of Eastern Ontario and Ottawa Hospital, University of Ottawa, Ottawa, ON, CanadaNeonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, QatarPharmacy Department, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, QatarNeonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, QatarNeonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, QatarNeonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, QatarPediatric Department, Weill Cornell Medicine-Qatar, Doha, QatarIntroductionDetermining the optimal dexamethasone dosage for facilitating extubation in extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) remains uncertain. This study aims to compare the effectiveness of low-dose (DART) and enhanced low-dose dexamethasone regimens in achieving successful extubation in these infants.MethodsWe conducted a retrospective cohort study at the Women's Wellness and Research Center (WWRC) involving ELBW infants who received dexamethasone for BPD prevention or treatment, or for extubation between January 1st, 2015, and December 31st, 2019. Our goal was to assess successful extubation within various time points of treatement.ResultsA total of 77 patients, matched in gestational age and BW, were enrolled in the study, receiving a total of 121 dexamethasone courses. Low-dose dexamethasone courses were administered 75 times to 49 infants, while 46 courses of enhanced low-dose were given to 28 infants. Treatment commenced at 30.8 ± 3.4 weeks post-menstrual age, compared to 32.1 ± 2.5 weeks in the enhanced low-dose group (p = 0.014). The median (IQR) course duration was seven (3–10) days in the low-dose group, while it was 10 (8–14) days in the enhanced low-dose group (p < 0.001). The median (IQR) course dose was 0.73 (0.53–0.86) mg/kg in the low-dose group and 1.27 (0.97–2.05) mg/kg in the enhanced low-dose group (p < 0.001). There were no differences in extubation success at any time point between the two groups at 72 h and seven days after treatment initiation, by course completion, and within seven days after treatment completion. However, regression analysis identified several predictors of successful extubation; baseline FiO2, course duration, and duration of invasive mechanical ventilation were negatively associated with successful extubation at various time points, while received dose per kg and cumulative dose positively correlated with successful extubation at different time points. No significant differences were observed in secondary outcomes, including death or BPD.ConclusionThe choice between low-dose and enhanced low-dose dexamethasone regimens may not significantly impact extubation success. However, careful consideration of dosing, ventilation status, and treatment duration remains crucial in achieving successful extubation. This study highlights the need for personalized dexamethasone therapy in ELBW infants.https://www.frontiersin.org/articles/10.3389/fped.2023.1261316/fullpostnatal steroidsdexamethasoneextremely low birth weightbronchopulmonary dysplasiachronic lung disease of prematurityRespiratory distress syndrome |
| spellingShingle | Heba Mohamed Al-taweel Ismail Sabry Ismail Abdelhady Nasreen Irfan Fadi Al Khzzam Abdullah Kamal Sudheer Babu Kurunthattil Thazhe Mohammad A. A. Bayoumi Ashraf Gad Ashraf Gad Comparing low-dose (DART) and enhanced low-dose dexamethasone regimens in preterm infants with bronchopulmonary dysplasia Frontiers in Pediatrics postnatal steroids dexamethasone extremely low birth weight bronchopulmonary dysplasia chronic lung disease of prematurity Respiratory distress syndrome |
| title | Comparing low-dose (DART) and enhanced low-dose dexamethasone regimens in preterm infants with bronchopulmonary dysplasia |
| title_full | Comparing low-dose (DART) and enhanced low-dose dexamethasone regimens in preterm infants with bronchopulmonary dysplasia |
| title_fullStr | Comparing low-dose (DART) and enhanced low-dose dexamethasone regimens in preterm infants with bronchopulmonary dysplasia |
| title_full_unstemmed | Comparing low-dose (DART) and enhanced low-dose dexamethasone regimens in preterm infants with bronchopulmonary dysplasia |
| title_short | Comparing low-dose (DART) and enhanced low-dose dexamethasone regimens in preterm infants with bronchopulmonary dysplasia |
| title_sort | comparing low dose dart and enhanced low dose dexamethasone regimens in preterm infants with bronchopulmonary dysplasia |
| topic | postnatal steroids dexamethasone extremely low birth weight bronchopulmonary dysplasia chronic lung disease of prematurity Respiratory distress syndrome |
| url | https://www.frontiersin.org/articles/10.3389/fped.2023.1261316/full |
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