Keywords
Dexamethasone
Infant
Premature
DART Protocol
How to Cite
Abstract
Objective: To evaluate whether late (>7 days) low-dose dexamethasone, given according to the DART protocol, improves respiratory parameters and facilitates extubation in ventilator-dependent preterm neonates, while also assessing short-term complications and BPD status at 36 weeks’ postmenstrual age.
Methods: This quasi-experimental study was conducted in the Department of Neonatology at the Pakistan Institute of Medical Sciences, Islamabad. Preterm neonates requiring mechanical and/or non-invasive ventilation received late (>7 days) low-dose dexamethasone using the Dexamethasone-Aided Respiratory Therapy (DART) protocol. The FiO₂ and mean airway pressure (MAP) were recorded before and during treatment. Dexamethasone was administered for up to 10 days and discontinued if pulmonary haemorrhage, intraventricular haemorrhage, or death occurred. The outcomes included changes in FiO₂ and MAP, extubation within 10 days, BPD at 36 weeks' postmenstrual age, and adverse events.
Results: Ninety-three infants were enrolled (mean gestational age 29.6±2.1 weeks; mean birth weight 1160±250 g). FiO₂ decreased from 0.56±0.11 to 0.33±0.08 (mean difference −0.229; 95% CI −0.251 to −0.208; p<0.001) and MAP from 12.3±2.5 to 8.9±2.0 cmH₂O (mean difference −3.40; 95% CI −3.91 to −2.90; p<0.001). Successful extubation occurred in 75.3% of the patients (70/93). BPD was diagnosed in 26.9% of patients at 36 weeks' postmenstrual age. Transient hyperglycaemia (11.8%) and hypertension (6.5%) were medically managed, and no gastrointestinal perforation or steroid-related mortality occurred.
Conclusion: Late low-dose dexamethasone administration via the DART protocol was associated with reduced ventilatory requirements and high extubation rates, with manageable short-term adverse effects. Controlled studies are needed to confirm its role in BPD prevention and refine patient selection in local NICU practices.
Keywords: Bronchopulmonary Dysplasia, Dexamethasone, DART, Anti-Inflammatory Agent, Infant, Premature.
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