243 - Multiple Courses of Dexamethasone Do Not Lead to Improved Outcomes in Premature Infants

Poster Number: 243
Publication Number: 243.2958

Background: Steroids are routinely employed in the neonatal intensive care unit (NICU), numerous studies have indicated that low-dose dexamethasone (the DART protocol) effectively reduces the duration of ventilator support. However, research has also highlighted the association of dexamethasone and long-term neurodevelopmental delays.

Objective: This study aims to investigate whether a higher cumulative duration of dexamethasone administration yields greater benefits in reducing the number of ventilator days compared to a single course of dexamethasone.

Design/Methods: We performed a retrospective cohort study of preterm infants, less than or equal to 32 weeks gestation in a level IV NICU, January 1st, 2021, to December 31st, 2022. The infants were primarily categorized based on whether they had undergone a single round of DART therapy or multiple rounds. Maternal and neonatal characteristic data were collected from the electronic medical record. Statistical analyses were performed using SPSS v29.0 software, analysis included Chi-square test for demographic characteristics and Mann-Whitney U test for non-parametric data, with significance set at p < 0.05.

Results: During the study period, a total of 54 premature infants were assessed, with 27 infants having received 10 days or fewer of steroids, and 27 infants having received more than 10 days of steroid treatment. The median gestational ages (GA) and birthweight (BW) for the group receiving fewer doses of steroids and the group receiving more doses were 26 weeks and 1021g, and 25 weeks and 793g, respectively (p-value 0.07 for GA and 0.008 for BW). The median number of ventilator days for the group receiving less steroids was 27, and for the group receiving more steroids it was 39, this difference was not statistically significant (p-value 0.09). The group receiving more steroids had a higher incidence of BPD and were more likely to be discharged on oxygen (p-values of 0.005 and < 0.001, respectively). Other factors did not demonstrate statistically significant associations

Conclusion(s): This study revealed that administering more than one course of dexamethasone did not result in a decrease in ventilator days or a reduction in the incidence of bronchopulmonary dysplasia (BPD) among two comparable cohorts of premature infants. These findings suggest that the use of additional steroids does not confer added benefits. Considering the known adverse effects of dexamethasone, utilizing this medication sparingly can ultimately lead to improved long-term outcomes for premature infants.