Fellow Cleveland Clinic Children's beachwood, Ohio, United States
Background: The low dose,10-day course of IV dexamethasone, DART, has been widely used to facilitate extubation in extremely low birth weight (ELBW) infants. DART trial demonstrated an initial success rate of extubation of about 60%, and a reduction in the duration of intubation, to a median of 14 days (IQR:5.5-21.5). Newer regimen has been proposed to improve success rate and achieve shorter duration to extubation. Objective: To examine if using DART intervention has been associated with improved successful extubation rates or less duration to successful extubation. Design/Methods: It is a retrospective analysis of outcome data of ELBW infants admitted at two neonatal intensive care units (NICU) between 2016-2022. Infants < 1000g BW who were admitted to the NICU were included while those expired in the delivery room were excluded. Data collected included gestational age (GA), BW, sex, surfactant therapy, total duration of intubation, number of DART courses, and total cumulative dose given. Successful extubation was defined as extubation during the 10-day DART course with no reintubation for 72 hours. Total duration of intubation and duration to successful extubation were calculated using mean + standard deviation (sd) and verified using median with 25th-75th interquartile ranges (IQR). Results: 421 ELBW infants were admitted to the NICU during the study period. Median GA was 25 wk (IQR:24.4-27.3), Mean BW was 719g. 70% of infants were intubated in the delivery room and 14% were intubated there after. 48% of the infants were intubated only once. 83% received surfactant therapy. 39% of the infants received dexamethasone therapy (DART), whereas 25% received only one course. Successful extubation occurred in 62% after the first DART course. Among those who could not be extubated or failed extubation, success rate ranged between 65-70% with repeated DART courses. Mean dexamethasone dose received was 1.8 mg (+2.4). Among intubated infants, mean total intubation days (d) was 19 (+25) with Median of 15(IQR:3-33). Among those who received DART, mean intubation days was 38(+28) and the median was 32 (IQR:19-46). Mean day of life (DOL) to start DART course was 22 (+11), with median of 18 (IQR:15-27). Mean days to initial extubation among those who received DART was 12 (+14) with Median of 6 (IQR:3-14). Success rate did not differ between infants < 750g compared to infants 750-999g (60%-62%) odds ratios 0.9 (CI:0.4-2.1, p= 0.67).
Conclusion(s): Outcomes of DART intervention did not improve overtime. The success of extubation remains similar and newer interventions need to be examined to achieve better success with extubation.
