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605 “Low dose” Postnatal Corticosteroids for Infants at Risk of Severe Bronchopulmonary Dysplasia
  1. C Pitan1,2
  1. 1Neonatology, Royal Women’s Hospital, Melbourne, VIC, Australia
  2. 2Paediatrics, University College Dublin, Dublin, Ireland

Abstract

Background Postnatal corticosteroids (PCS) improve short term lung function but may increase the risk of disability in later life. The Dexamethasone: A Randomised Trial (DART) study was designed to address this risk using a 10 day tapering regimen with a total dose of 890 micrograms/kg. The Royal Women’s Hospital, Melbourne selects patients at high risk of bronchopulmonary dysplasia (BPD) to receive steroids as per the DART protocol. The primary aim of this study was to audit the prescribing practices of the DART protocol with a secondary aims of reporting patient outcomes.

Method Patients were identified from an electronic database between January 2006 and December 2009 and medical records reviewed. Infants prescribed PCS other than as per the DART protocol and for preventing BPD were excluded.

Results Forty six infants with mean (SD) gestational age of 25.0 (1.3) weeks and birth weight of 685 (192) g were prescribed dexamethasone. Median (range) duration of therapy was 20 (3–86) days with a median total dexamethasone dose of 1437 (375–9100) micrograms/kg. There were significant changes on day 3 of treatment in mean airway pressure (MAP) or positive end expiratory pressure (PEEP), p<0.001 and percentage inspired oxygen (FiO2), p<0.001. There were seven deaths, with the combined outcome of either death or BPD occurring in 41 (89%) infants.

Conclusions In our audit prescribing practices deviating outside of hospital protocol, resulting in doses exceeding those recommended. Clinical practice review of PCS therapy in preterm infants is encouraged.

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