Dexamethasone Use to Reduce Mechanical Ventilation and Bronchopulmonary Dysplasia in the Neonatal Intensive Care Unit.

The Canadian journal of hospital pharmacy Pub Date : 2024-08-14 eCollection Date: 2024-01-01 DOI:10.4212/cjhp.3523
Sandeep Padam, Brandi Newby, Luo Lora Wang
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Abstract

Background: Ventilator-dependent neonates are at risk of bronchopulmonary dysplasia (BPD), a chronic lung disease. Dexamethasone may be used to facilitate extubation and reduce the incidence of BPD.

Objectives: To determine the efficacy of dexamethasone in reducing the incidence of established BPD at 36 weeks postmenstrual age (PMA); to establish the rate of extubation success; to determine the factors affecting extubation success; and to describe complications associated with dexamethasone therapy.

Methods: A chart review was conducted at Surrey Memorial Hospital, in Surrey, British Columbia, for neonates who received dexamethasone to reduce the development of BPD between July 1, 2016, and June 30, 2022.

Results: A total of 47 neonates met the inclusion criteria. Of the 45 neonates still alive at 36 weeks PMA, all (100%) had BPD. Use of dexamethasone led to extubation success for 21 (47%) of these 45 neonates. The mean PMA at dexamethasone initiation was 30.7 weeks for neonates with extubation success, compared with 28.6 weeks for those with extubation failure (p = 0.001). Complications occurred in 43 (91%) of the 47 neonates.

Conclusions: BPD occurred in all of the neonates, despite a 47% extubation success rate. The timing of dexamethasone initiation was associated with extubation success. Further research is required to determine the dose and timing of dexamethasone needed to reduce the incidence of BPD.

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使用地塞米松减少新生儿重症监护室的机械通气和支气管肺发育不良。
背景:依赖呼吸机的新生儿有患支气管肺发育不良(BPD)这一慢性肺部疾病的风险。地塞米松可用于促进拔管并降低 BPD 的发病率:确定地塞米松在降低月龄后 36 周(PMA)已确诊 BPD 的发病率方面的疗效;确定拔管成功率;确定影响拔管成功的因素;并描述与地塞米松治疗相关的并发症:在不列颠哥伦比亚省素里市的素里纪念医院对2016年7月1日至2022年6月30日期间接受地塞米松治疗以减少BPD发展的新生儿进行了病历审查:共有 47 名新生儿符合纳入标准。在PMA 36周时仍然存活的45名新生儿中,全部(100%)患有BPD。使用地塞米松后,这 45 名新生儿中有 21 名(47%)成功拔管。拔管成功的新生儿在开始使用地塞米松时的平均 PMA 为 30.7 周,而拔管失败的新生儿为 28.6 周(P = 0.001)。47名新生儿中有43名(91%)出现并发症:结论:尽管拔管成功率为 47%,但所有新生儿都出现了 BPD。开始使用地塞米松的时间与拔管成功率有关。需要进一步研究确定地塞米松的剂量和时机,以降低 BPD 的发生率。
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