Dexamethasone therapy in neonates treated with extracorporeal membrane oxygenation

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Abstract

Objective

To test the hypothesis that infants who received dexamethasone would have a shorter length of time on extracorporeal membrane oxygenation (ECMO).

Study design

Infants placed on ECMO for respiratory failure were randomly assigned to receive either dexamethasone for 3 days or placebo. Chest radiographs were scored through the use of a validated standard scoring system to assess lung injury.

Results

Thirty infants received dexamethasone and 29 received placebo. The median (25th%, 75th%) duration of time on ECMO was 143.5 (100, 313) hours in the dexamethasone group and 160 (111, 303) hours in the placebo group (not significant). Survival was 80% in the dexamethasone group and 83% in the placebo group. Radiographic lung injury scores (mean±SEM) were significantly improved in the dexamethasone group (10.5±0.6) versus placebo (12.3±0.5) on day 3 of ECMO (P = .013). Hypertension developed in 27 of the 30 infants receiving dexamethasone and 13 of the 29 infants in the placebo group during ECMO (P<.01).

Conclusions

Dexamethasone given during the first 3 days of ECMO results in significant improvement in lung injury scores by day 3 of ECMO but does not significantly decrease the duration of ECMO or improve survival. The preponderance of evidence would not support the use of dexamethasone in this setting.

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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