257 - Early Course of Post-natal Dexamethasone and Its Impact on Respiratory Outcomes in Preterm Neonates

Publication Number: 257.5027

Noor Mehandi, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States; Augusto Schmidt, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States; Alini Schott, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States; Ana Cecilia. Aguilar, University of Miami, Miami, FL, United States; Eduardo Bancalari, University of Miami, Miami, FL, United States; Nelson Claure, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States

Background: The 2022 AAP policy statement on postnatal corticosteroids to prevent or treat Bronchopulmonary Dysplasia (BPD) emphasized the lack of unambiguous evidence. Dexamethasone is being increasingly used at an earlier postnatal age to facilitate extubation in preterm infants. In 2022, our Level 4 NICU revised its recommendation to consider the use of dexamethasone for extubation at an earlier age of 14 to 21 days after birth. However, the impact on duration of respiratory support and BPD remains unknown.

Objective: To compare the effect of earlier versus later first course of post-natal dexamethasone (PND) on the duration of invasive mechanical ventilation (MV), the duration of oxygen (O2) supplementation, and the incidence of BPD.

Design/Methods: Data collected prospectively from a cohort of infants born between 22 and 30 weeks gestational age (GA) who were admitted to the Level 4 NICU at Holtz Children’s Hospital, University of Miami/Jackson Memorial Medical Center, from 2020-2023. Preterm infants who received PND and were alive at 36 weeks postmenstrual age (PMA) were analyzed. Early PND was defined as first course starting at or before day 21. BPD was defined according to the 2001 NIH consensus at 36 weeks PMA. Respiratory severity was calculated based on FiO2 ≥ .3 and on MV at d1 and d14.

Results: A total of 146 infants who received PND and were alive at 36 weeks PMA during 2020 – 2023 were included. Of these, 25 received early PND, and 121 received late PND. The median age of receiving the early course of PND was day 16 (IQR 15, 19) and the late course of PND was day 34 (IQR 27, 47). Among the baseline patient characteristics, birth weight was statistically different, with larger babies receiving the earlier course, while gestational age at birth, respiratory severity at day 1 and day 14 did not differ significantly (Table 1). The duration of MV and hospitalization were significantly shorter in the early PND group compared to the late PND group. The duration on oxygen and the incidence of moderate-severe or severe BPD did not differ significantly between early and late PND (Table 2).

Conclusion(s): The early first course of PND to facilitate extubation resulted in a reduction in the duration of MV and hospitalization. However, this was not accompanied by a reduction in the incidence of BPD. The short- and long-term impacts of these strategies need to be further investigated.

Table 1: Baseline Characteristics


Table 2: Respiratory Outcomes