1016 Early dexamethasone (dex) to prevent bronchopulmonary dysplasia (BPD)

Adminstration of early (first week), prophylactic dex in possible candidates for BPD has been studied over the past two decades in several centres, involving thousands of infants. Many of these studies have appropriately been randomized and controlled against placebo, but a number have involved woefully small numbers of patients (20 – 40). In an attempt to clarify whether early dex has a role in preventing BPD, a group from the UK, USA and Australia performed a well-designed and researched systematic review, and ultimately ‘meta-analysed’ 20 eligible studies involving 2860 infants. Reading their article’s abstract and its conclusion one would believe that the benefits of first week dex to prevent BPD do not outweigh risks and adverse events, and the intervention cannot be recommended as routine clinical practice. Specifically, they concluded that benefits included reductions in BPD at 28 days and 36 weeks (postmenstrual age), patent ductus arteriosus, severe retinopathy, failure to extubate by 7 days, and late rescue with corticosteroids. On the other hand, dex was associated with more hypertension, hyperglycaemia, gastrointestinal bleeding and perforation and, in the seven studies that included longer term follow-up, significantly more cerebral palsy. From this one assumes that at least in the units that participated in this study the use of dex would in future not be accepted as a treatment option. However the concluding statements in the article itself demonstrate once again that meta-analyses frequently identify deficiencies in the underlying research rather than provide practitioners with definitive answers. One of the shortcomings is that the critical cerebral palsy data are incomplete (insufficient cases, not followed for long enough, early rates might be higher than if reassessed later). This once again highlights the need for neonatologists to follow and study patients for as long as possible. The other point made by the authors for any who wish to continue to explore the risks vs benefits of early dex, is that there should be attempts to identify and include only the infants at greatest risk for BPD so that one is not routinely administering a drug with potentially-harmful effects.

Read more:
Neonatology 2010; 98: 217-24
Intensive Care Med 1999; 25: 717-21
Pediatrics 2002; 109;e85