Effect of five days of dexamethasone therapy on ventilator dependence and adrenocorticotropic hormone-stimulated cortisol concentrations

Abstract

Objective: Our objective was to address the efficacy of 5 days of dexamethasone therapy in preterm infants dependent on ventilation and to measure adrenocorticotropic hormone-stimulated cortisol release after therapy.

Methods: This was a randomized, masked trial. Results were evaluated with Fisher's exact test and Wilcoxon test. Fifteen preterm infants in a newborn intensive care unit who were dependent on ventilation were enrolled at 8 to 24 days of age. Dexamethasone or normal saline solution was used for treatment. The main outcome measure was ventilator independence.

Results: Dexamethasone therapy correlated to successful extubation. Posttherapy peak adrenocorticotropic hormone-stimulated cortisol concentrations were lower in infants treated with dexamethasone than in infants treated with saline solution.

Conclusions: A 5-day course of dexamethasone may be adequate to achieve ventilator independence. The difference in peak cortisol concentrations may reflect suppression of the hypothalamic-pituitary-adrenal axis by dexamethasone or a higher peak cortisol response in the infants treated with saline solution who have higher ventilatory acuity after therapy.