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Titolo:
EFFECTS OF EARLY DEXAMETHASONE THERAPY ON PULMONARY MECHANICS AND CHRONIC LUNG-DISEASE IN VERY-LOW-BIRTH-WEIGHT INFANTS - A RANDOMIZED, CONTROLLED TRIAL
Autore:
DURAND M; SARDESAI S; MCEVOY C;
Indirizzi:
UNIV SO CALIF,LOS ANGELES CTY MED CTR,WOMENS & CHILDRENS HOSP,ROOM L-919,1240 N MISS RD LOS ANGELES CA 90033 UNIV SO CALIF,LOS ANGELES CTY MED CTR,DIV NEONATAL PERINATAL MED LOS ANGELES CA 90033 UNIV SO CALIF,SCH MED,DEPT PEDIAT LOS ANGELES CA 00000
Titolo Testata:
Pediatrics
fascicolo: 4, volume: 95, anno: 1995,
pagine: 584 - 590
SICI:
0031-4005(1995)95:4<584:EOEDTO>2.0.ZU;2-E
Fonte:
ISI
Lingua:
ENG
Soggetto:
RESPIRATORY-DISTRESS SYNDROME; PITUITARY-ADRENAL AXIS; BRONCHOPULMONARY DYSPLASIA; PRETERM INFANTS; DEPENDENT INFANTS; PREMATURE-INFANTS; SYNTHETIC SURFACTANT; RETINOPATHY; SECRETIONS; PRESSURE;
Keywords:
RESPIRATORY MECHANICS; DEXAMETHASONE THERAPY; CHRONIC LUNG DISEASE; VERY LOW BIRTH WEIGHT INFANTS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
38
Recensione:
Indirizzi per estratti:
Citazione:
M. Durand et al., "EFFECTS OF EARLY DEXAMETHASONE THERAPY ON PULMONARY MECHANICS AND CHRONIC LUNG-DISEASE IN VERY-LOW-BIRTH-WEIGHT INFANTS - A RANDOMIZED, CONTROLLED TRIAL", Pediatrics, 95(4), 1995, pp. 584-590

Abstract

Objective. To determine the changes in pulmonary mechanics before andduring early dexamethasone therapy, and to evaluate the effect of dexamethasone on the duration of mechanical ventilation in very low birthweight (VLBW) ventilator-dependent infants at risk for chronic lung disease (CLD). Methods. A prospective randomized trial was conducted. Forty-three patients (birth weight 600 to 1500 g, gestational age 24 to32 weeks) who failed to be weaned from the respirator at 7 to 14 daysof age were enrolled; 23 infants received a 7-day course of dexamethasone (0.5 mg/kg/day intravenously for 3 days, 0.25 mg/kg/day for 3 days, and 0.1 mg/kg/day for 1 day), and 20 patients were in the control group. At similar mean airway pressure (MAP) and fractional inspired oxygen concentration (FiO(2)), respiratory system mechanics were measured before and on days 2, 5, and 7 of the study. Airway pressure, flow and tidal volume (V-T) were recorded and only mechanical breaths were analyzed. Respiratory compliance (C-rs) and respiratory resistance (R(rs)) were calculated by two factor least mean square analysis. Results. Eighty-three percent of infants in the dexamethasone group and 90% inthe control group received surfactant in the first 24 hours of life. There was a significant increase in C-rs and V-T in the dexamethasone group as compared with the control group (P < .001). No major changes in R(rs) were observed. Dexamethasone therapy significantly decreased FiO(2) and MAP P < .001) and facilitated successful weaning from mechanical ventilation. In addition to a shorter duration of mechanical ventilation (P < .01), the occurrence of CLD (FiO(2) > 0.21 at 36 weeks of corrected gestational age, chest radiograph changes) was significantly decreased in the dexamethasone group (P < .01). Except for a transient increase in blood pressure and serum glucose, there were no significant differences in infection rates, intraventricular hemorrhage, or retinopathy of prematurity. Thirteen patients in the control group received dexamethasone at a later age. Conclusions. Our findings indicatethat: 1) early dexamethasone therapy in VLBW infants markedly improves respiratory compliance and tidal volume, reduces FiO(2) and MAP requirements, and facilitates extubation in these infants; 2) early dexamethasone therapy reduces the duration of mechanical ventilation and decreases CLD (at 28 days and 36 weeks) in a population of VLBW infants largely treated with surfactant.

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Documento generato il 06/04/20 alle ore 02:08:59