260 - Clinical Outcomes in Infants with Evolving or Established Bronchopulmonary Dysplasia Who Receive a Very Late Course of Low versus Moderate Dose Dexamethasone

Publication Number: 260.4146

Shawn K. Ahlfeld, Cincinnati Children’s Hospital Medical Center, Fort Thomas, KY, United States; Melissa House, Emory University School of Medicine, Atlanta, GA, United States; Kathryn Hasselfeld, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Bronchopulmonary dysplasia is a disorder of lung development commonly associated with pulmonary inflammation. When pulmonary inflammation is long-standing, systemic corticosteroids are often used in an attempt to avoid tracheostomy. Although several studies have focused on moderate-dose systemic corticosteroids to prevent bronchopulmonary dysplasia, very few studies have looked at the use of systemic steroids to treat established lung disease.

Objective: The aim of our study was to determine if systemic dexamethasone used at ≥ 34 weeks postmenstrual age (PMA) in infants with evolving, severe chronic respiratory failure aids in weaning respiratory support and if so, whether a higher dose is more effective.

Design/Methods: This retrospective cohort study included 80 infants born at less than 33 weeks gestation, admitted to a Level IV NICU from January 2016 to September 2023, that demonstrated ongoing, severe respiratory failure and received a very late course (≥34 weeks PMA) of low-dose (0.89 mg/kg) versus moderate-dose (3.025 mg/kg) dexamethasone.

Results: Despite infants in the low-dose group requiring more invasive ventilation (79% vs 56%, p = 0.03) and having higher respiratory severity scores (6.2 [IQR 3.6-10.3] vs 3.3 [IQR 0.5–7.8], p = 0.01) at the initiation of dexamethasone, there was no significant difference between the groups in the ability to wean respiratory support (69% vs 66%, p = 0.75) or achieve extubation (74% vs 52%, p = 0.09) by course completion. Additionally, although infants in the moderate-dose group had received their initial postnatal steroid courses sooner (DOL 21 vs DOL 36, p < 0.001), were exposed to inhaled corticosteroids and bronchodilators more often (90% vs 38%, p < 0.001; 68% vs 26%, p < 0.001), had higher overall steroid exposure (4.2 mg/kg vs 1.8 mg/kg of dexamethasone, p < 0.001), and ultimately had a lower incidence of grade 3 bronchopulmonary dysplasia (46% vs 69%, p = 0.04), there was no significant difference in the need for tracheostomy (41% vs 54%, p = 0.27). There were no differences in immediate side effects or growth outcomes, but more infants in the moderate-dose group had an abnormal fidgety GMA (49% vs 17%, p =0.01).

Conclusion(s): When given at ≥ 34 weeks PMA, systemic dexamethasone is effective in helping wean respiratory support in infants with evolving or established bronchopulmonary dysplasia. However, a higher dose does not appear to be more effective and may be associated with worse neurodevelopmental outcomes.