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A dose-limited dexamethasone and bubble CPAP in ventilation-dependent extremely premature infants.

BACKGROUND
Dexamethasone has been associated with early extubation and shorter duration of mechanical ventilation in preterm infants. High doses or prolonged courses of dexamethasone may be associated with poor neurodevelopmental outcomes.


METHODS
This is an observational cohort study assessing the efficacy of a low dose short dexamethasone course combined with post-extubation bubble continuous positive airway pressure (CPAP) strategy on rates of successful extubation and reduction of the duration of invasive mechanical ventilation in extremely preterm infants. We compared the short term outcomes of implementing such strategy on a group of infants with birth weight <750g to a historical cohort.


RESULTS
Among infants intubated for at least 10 days, median time to extubation from starting the dexamethasone course was 2 days (IQR: 1-3). Total duration of intubation was significantly shorter in infants received dexamethasone compared to the control groups (21 +/-6 days vs. 30 +/-10 days, p= 0.03), and although statistically non-significant, duration to wean to 21% bCPAP was shorter compared to the control group (48 +/-13 days vs. 74 +/-29 days, p= 0.06).


CONCLUSIONS
A low-dose short dexamethasone course combined with post extubation bubble CPAP intervention may be associated with successful early extubation and shorter duration of mechanical ventilation.