Background Prescribing postnatal corticosteroids (PCS) for ventilator dependent preterm infant remains controversial. PCS improve short term lung function but may increase the risk of disability in later life. The DART study1 was designed to address this risk using a 10-day tapering protocol with a total dose of dexamethasone of 0.89 mg/kg. We aimed to audit practice and calculate the total dose of PCS at a single centre using the DART protocol.
Method Over a four year period patients were identified from an electronic database and hospital charts reviewed. Infants receiving peri-extubation steroids were excluded.
Results Forty six infants with mean (SD) gestational age 25.0 (1.3) weeks, birth weight 685 (192) g received PCS as per DART protocol at a median (range) age of 25(6–197) days. Ventilatory support at the start of treatment: 6 infants on CPAP, 24 conventional and 16 high frequency ventilation. Mean FiO2 prior to PCS was 0.55 (0.22) with mean airway pressure of 10.9 (2.7) falling to 9.1 (2.3) cm H2O after three days. Median duration of therapy was 20 (3–86)days, with a total dexamethasone dose of 1.44 (0.375–9.1) mg/kg. Glycosuria was common (67%), one infant developed NEC and there were seven deaths with a 93% rate of either death or BPD (oxygen dependency at 36 weeks).
Conclusions PCS prescribed beyond three weeks has minimal impact on reducing BPD despite the total dose of PCS often exceeding those used in published studies. Long term follow up of these patients is recommended.
Reference 1 Doyle et al. Pediatrics 2006;117:75–83