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The use of Dexamethasone in full‐term infants with severe respiratory failure and pulmonary barotrauma

Eight full‐term infants (mean gestation 39.9 weeks [range 37‐42] and mean birthweight 3642 g [range 3060‐4200]) with severe respiratory failure (median oxygenation index 28 [range 16‐65] and median arterial/alveolar Po2 ratio (a/APo2) 0.094 [range 0.038‐0.165]) and pulmonary barotrauma were treated with Dexamethasone, 0.5 mg/kg per day, from the median age of 5 days (range 3‐22). Six of the eight (75%) infants survived. They were weaned from mechanical ventilation and extubated a median of 2.5 days after commencing treatment with Dexamethasone. Two infants died and one of them suffered recurrent pneumothoraces. There was a significant improvement in oxygenation in the seven infants who survived the 72 h period of observation. Their median oxygenation index was 24 when Dexamethasone was commenced compared with 8 after 12 h (P <0.05) and 10 after 36 h (P <0.025). Their a/APo2, ratio was 0.095 when Dexamethasone was commenced compared with 0.289 after 12 h (P <0.05) and 0.207 after 36 h (P <0.025). There was a significant increase in the infants' arterial mean blood pressure associated with Dexamethasone therapy and one infant developed Staphylococcus aureus septicaemia. In this uncontrolled study of eight full‐term infants with severe respiratory failure and pulmonary barotrauma, the use of Dexamethasone was associated with significant improvement in oxygenation and rapid weaning from mechanical ventilation.