Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2000;2001(2):CD000308.
doi: 10.1002/14651858.CD000308.

Intravenous dexamethasone for extubation of newborn infants

P G Davis  1 , D J Henderson-Smart
Affiliations

Intravenous dexamethasone for extubation of newborn infants

P G Davis et al. Cochrane Database Syst Rev. 2000.

Update in

Abstract

Background: Endotracheal tubes are foreign bodies that may injure the upper airway causing laryngeal edema. This in turn may result in failure of extubation in preterm infants. Corticosteroids have been used prophylactically to reduce upper airway obstruction and facilitate extubation.

Objectives: In newborn infants having their endotracheal tube removed following a period of intermittent positive pressure ventilation (IPPV), what are the effects of intravenous corticosteroids on the incidence of endotracheal reintubation, stridor, atelectasis and adverse side effects?

Search strategy: Searches were made of the Oxford Database of Perinatal Trials, Medline (MeSH search terms "dexamethasone", "extubat*" and "exp infant, newborn"), previous reviews including cross references, abstracts of conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language and expert informant searches in the Japanese language by Prof. Y. Ogawa.

Selection criteria: Trials were included which used random or quasi-random patient allocation, and which compared intravenous steroids given immediately prior to a planned extubation with placebo.

Data collection and analysis: Data were extracted independently by the two authors and analysed in Revman for all trials. Prespecified subgroup analyses were performed to examine differences in response between infants at high risk for upper airway edema and those receiving routine prophylaxis prior to extubation.

Main results: Administration of dexamethasone prior to extubation significantly reduced the need for reintubation of the trachea. This result applies to both the high risk group and to the total population of infants enrolled. However, the incidence of extubation failure was zero in the trial that attempted to exclude infants at high risk of airway edema. The side effects of higher blood sugar levels and glycosuria were found in the 2 trials where these were sought.

Reviewer's conclusions: Implications for practice Dexamethasone reduces the need for endotracheal reintubation of neonates after a period of IPPV. In view of the lack of effect in low risk infants and the documented and potential side effects, it appears reasonable to restrict its use to infants at increased risk for airway edema and obstruction, such as those who have received repeated or prolonged intubations. Implications for research Issues of dosage and applicability to the extremely low birthweight population could be addressed in future trials. Longer term outcomes such as chronic lung disease, duration of assisted ventilation and length of hospital stay should also be examined.

PubMed Disclaimer

Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 Dexamethasone vs Placebo (all infants), Outcome 1 Endotracheal reintubation.
1.2
1.2. Analysis
Comparison 1 Dexamethasone vs Placebo (all infants), Outcome 2 Postextubation stridor.
1.3
1.3. Analysis
Comparison 1 Dexamethasone vs Placebo (all infants), Outcome 3 Postextubation atelectasis.
1.4
1.4. Analysis
Comparison 1 Dexamethasone vs Placebo (all infants), Outcome 4 Glycosuria.
1.5
1.5. Analysis
Comparison 1 Dexamethasone vs Placebo (all infants), Outcome 5 Subglottic stenosis.
2.1
2.1. Analysis
Comparison 2 Dexamethasone vs Placebo (high risk patients), Outcome 1 Endotracheal reintubation.
2.2
2.2. Analysis
Comparison 2 Dexamethasone vs Placebo (high risk patients), Outcome 2 Stridor.
2.3
2.3. Analysis
Comparison 2 Dexamethasone vs Placebo (high risk patients), Outcome 3 Subglottic stenosis.
3.1
3.1. Analysis
Comparison 3 Dexamethasone vs Placebo (multiple dose), Outcome 1 Postextubation stridor.
4.1
4.1. Analysis
Comparison 4 Dexamethasone vs Placebo (single dose), Outcome 1 Postextubation stridor.
See this image and copyright information in PMC

References

References to studies included in this review

Courtney 1992 {published data only}
    1. Courtney SE, Weber KR, Gumo SS, Spohn WA, Bender CV, Malin SW. Randomized trial of dexamethasone (D) for prevention of post extubation laryngeal edema following extubation. Pediatric Research 1989;25:34A.
    1. Courtney SE, Weber KR, Siervogel RM, Spohn WA, Guo S, Malin SW, Bender CV. Effects of dexamethasone on pulmonary function following extubation. Journal of Perinatology 1992;12:246‐51. - PubMed
    1. Courtney SE, Weber KR, Spohn WA, Bender CV, Malin SW, Guo S, Siervogel RM. Dexamethasone (D) for prevention of post extubation laryngeal edema following extubation. Pediatric Research 1988;23:502A.
Couser 1992 {published data only}
    1. Couser RJ, Ferrara TB, Falde B, Johnson K, Schilling CG, Hoekstra RE. Effectiveness of dexamethasone in preventing extubation failure in preterm infants at increased risk for airway edema. Journal of Pediatrics 1992;121:591‐6. - PubMed
Ferrara 1989 {published data only}
    1. Ferrara TB, Georgieff MK, Ebert J, Figher JB. Routine use of dexamethasone for prevention of postextubation respiratory distress. Journal of Perinatology 1989;9:287‐90. - PubMed

Additional references

Arensman 1988
    1. Arensman RM. Surgical management of the airway. In: Goldsmith JP, Karotkin EH editor(s). Assisted ventilation of the neonate. Philadelphia: WB Saunders, 1988:342‐56.
Carlo 1992
    1. Carlo WA, Martin RJ, Fanaroff AA. Assisted ventilation and the complications of respiratory distress. Neonatal‐Perinatal Medicine: Diseases of the fetus and infant. 1992:820‐34.
Davies 1998
    1. Davies MW, Davis PG. Nebulized racemic epinephrine in infants being extubated. Cochrane Database of Systematic Reviews 1998, Issue 3.
Durand 1995
    1. Durand M, Sardesi S, McEvoy C. Effects of early dexamethasone therapy on pulmonary mechanics and chronic lung disease in very low birth weight infants: A randomized, controlled trial. Pediatrics 1995;95:584‐90. - PubMed
Halliday 2003
    1. Halliday HL, Ehrenkranz RA, Doyle LW. Early postnatal (<96 hours) corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database of Systematic Reviews 2003, Issue 1. - PubMed
Tellez 1991
    1. Tellez DW, Galvis AG, Storgion SA, Amer HN, Hoseyni M, Deakers TM. Dexamethasone in the prevention of postextubation stridor in children. Journal of Pediatrics 1991;118:289‐94. - PubMed

References to other published versions of this review

Davis 1999
    1. Davis PG, Henderson‐Smart DJ. Intravenous dexamethone in neonates being extubated. Cochrane Database of Systematic Reviews 1999, Issue 1.
Davis 2001
    1. Davis PG, Henderson‐Smart DJ. Intravenous dexamethasone for extubation of newborn infants. Cochrane Database of Systematic Reviews 2001, Issue 4. - PubMed

Publication types

MeSH terms

LinkOut - more resources