A Prospective, Randomized, Double-Masked Trial Comparing Low Dose to Conventional Dose Dexamethasone in Neonatal Chronic Lung Disease

Aim: To determine if low dose dexamethasone for the treatment of chronic lung disease would be as effective as high dose with less adverse effects. Methods: A prospective, randomized, double-blinded trial of infants ≤1500 grams, ≤34 weeks, and ≤28 days of age. The high dose group received 0.5 mg/kg/d of dexamethasone for three days followed by 0.3mg/kg/d for four days. The low dose group received 0.08 mg/kg/d of dexamethasone for seven days. Results: Infants in the low and high dose groups had similar weights, gestational ages at birth, male to female ratios, and entry FiO2. The groups were similar in terms of proportion extubated during steroid course, change in FiO2, O2 requirement at 36 weeks, hospital days, ventilator days, and effect on the hypothalamic-pituitary-adrenal axis. The high dose group had significantly more patients who required treatment for hypertension and more abnormal neurodevelopmental outcomes at one year adjusted age. The high dose group also had slower weight gain, slower head growth, more patients with hyperglycemia, and a smaller mean head circumference at one year adjusted age, although these differences did not reach statistical significance. Conclusions: Compared to low dose dexamethasone, conventional dosing was associated with similar pulmonary outcomes and more adverse side effects.