Single-dose dexamethasone treatment of hypotension in preterm infants,☆☆

Presented in part at the 1998 Annual Meeting of the European Society for Pediatric Research, Belfast, Northern Ireland, September 13-17, 1998.
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Abstract

Objective: To test the efficacy of single-dose dexamethasone (DXM) in the management of severe arterial hypotension of newborn infants. Our hypothesis was that epinephrine infusions could be discontinued in 70% of patients within 12 hours after DXM administration compared with 10% in the placebo group. Study design: Twenty preterm infants (median birth weight 690 g, gestational age 28 weeks, age at intervention 2 days) who did not respond to a standardized treatment protocol (blood/colloid followed by dopamine infusion stepwise increased to 15 μg/kg and minute) were started on an epinephrine infusion and were randomly allocated to receive either DXM (0.25 mg/kg) or placebo intravenously. The primary outcome criterion was the need for an epinephrine infusion 12 hours after treatment. Results: Three infants were excluded. Epinephrine infusion was discontinued in 5 of 8 infants with DXM but in only 1 of 9 infants in the control group. The duration of epinephrine infusion was significantly shorter in the DXM group (exact log-rank test, P = .023). Conclusions: DXM was effective for the management of severe arterial hypotension in preterm infants not responding to standardized treatment. (J Pediatr 1999;134:701-5)

Section snippets

Definition of Arterial Hypotension

Arterial hypotension was defined as directly measured mean arterial blood pressure readings lower than the individually determined minimum blood pressure. Because there are no reliable reference values for arterial blood pressure in very premature born infants, an individual minimum blood pressure was established for each infant and defined as the pressure required to maintain adequate diuresis at a capillary filling time of <2 to 3 seconds. For orientation the following minimum blood pressure

Sample

Between November 1994 and June 1996, 20 newborn infants were enrolled. Three were excluded later from the analysis. Between August 1996 and July 1997, 2 further children were enrolled in the study. In 1 of these children (placebo), hypertrophic obstructive cardiomyopathy led to exclusion from the study. Thus in July 1997, a group of 17 very low birth weight infants, 8 of whom were in the DXM group and 9 in the placebo group, was evaluated. Based on a new calculation of power, we decided to

DISCUSSION

Consistent with our retrospective cohort study14 we now show in a double-blind, placebo-controlled study that a single dose of 0.25 mg DXM is effective within 12 hours in improving severe arterial hypotension in preterm infants unresponsive to volume expansion and dopamine infusion. This effect was also seen after rescue administration of DXM at the end of the 12-hour study period.

Five infants, 3 of the study group and 2 after rescue treatment with DXM, had a delayed response to DXM within 13

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    Reprint requests: Frank Pohlandt, MD, Universitätskinderklinik Ulm, D-89070 Ulm, Germany.

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