Dexamethasone therapy in neonates treated with extracorporeal membrane oxygenation
Section snippets
Patient population
This clinical trial was a prospective, randomized, double-masked, controlled study. Infants in the neonatal intensive care unit at the University of Virginia from June 1993 to February 2002 with respiratory failure and who met our institution's criteria for ECMO were eligible for enrollment. Briefly, our criteria for ECMO are gestational age >34 weeks, no evidence of severe brain injury or intracranial hemorrhage, and severe respiratory failure indicated by an oxygenation index >40 on multiple
Results
During the study period, 104 infants had respiratory failure and received ECMO. Fifty-nine infants were enrolled in the study, and 30 received dexamethasone. There was no difference between groups for birth weight or gestational age (Table). Interestingly, the infants in the placebo group had lower 1- and 5-minute APGAR scores that reached statistical significance. If anything, this could have biased the results in favor of the dexamethasone group. There was, however, no statistical difference
Discussion
We carried out a randomized, controlled trial to examine the role of multiple doses of dexamethasone in neonates undergoing ECMO for respiratory failure. One earlier study from 1991 investigated the use of a single dose of methylprednisolone before ECMO in neonates with respiratory failure.10 The group receiving methylprednisolone had a significantly shorter time on ECMO, with no difference in survival. We undertook our study knowing that steroids had been used with some success in premature
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