Repeat steroid treatment less effective at weaning BPD infants off ventilatory support

In infants with bronchopulmonary dysplasia (BPD), treatment with two dexamethasone courses does not appear to be more advantageous than a single course in terms of weaning respiratory support, a study reports. Nevertheless, repeat treatment has a null effect on growth trajectory to discharge.

The analysis involved 132 dexamethasone-treated infants with BPD (mean gestational age 25.2 weeks, mean birthweight 727 grams) and 147 untreated controls. Of the treated infants, 80 received a single dexamethasone course and 52 were administered repeat treatment.

Treatment efficacy was defined as successful step-down in respiratory support by end of treatment. Meanwhile, safety was assessed as adverse effects on growth.

Overall, infants who received one or two courses of dexamethasone for BPD had comparable baseline characteristics, including gestational age and birthweight. Infants who received repeat treatment were more likely to be small for gestational age and from twin gestation. Moreover, clinical outcomes such as rates of severe BPD, tracheostomy, and gastrostomy tube were higher among infants treated with repeat dexamethasone.

In terms of efficacy, 69 out of 132 (52 percent) infants treated with a single course of dexamethasone achieved step-down in respiratory support. In comparison, only 20 out of 52 (38 percent) infants who received repeat dexamethasone treatment were weaned.

Even so, growth trajectory did not significantly differ among infants treated with a single or two courses of dexamethasone as compared with controls (p=0.23 for weight; p=0.68 for length; p=0.77 for head circumference).