Randomized trial of antenatal dexamethasone in surfactant-treated infants delivered before 30 weeks' gestation

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 87; no. 5; pp. 683 - 691
• Main Authors: Silver, Richard K., Vyskocil, Christine, Solomon, Shari L., Ragin, Ann, Neerhof, Mark G., Farrell, Elaine E.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-1996; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Cerebral Hemorrhage - epidemiology; Cerebral Hemorrhage - prevention & control; Dexamethasone - therapeutic use; Double-Blind Method; Drug Administration Schedule; Female; Glucocorticoids - therapeutic use; Humans; Incidence; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - epidemiology; Infant, Premature, Diseases - prevention & control; Logistic Models; Male; Medical sciences; Pharmacology. Drug treatments; Pregnancy; Prenatal Care; Pulmonary Surfactants - therapeutic use; Respiratory Distress Syndrome, Newborn - epidemiology; Respiratory Distress Syndrome, Newborn - prevention & control; Respiratory system; Risk Factors; Severity of Illness Index; Human; Premature; Corticosteroid; Dexamethasone; Respiratory disease; Treatment efficiency; Premature delivery; Prenatal; Prevention; Newborn diseases; Chemotherapy; Newborn; Postnatal; Treatment; Pulmonary surfactant; Delivery disorders; Respiratory distress; Clinical trial
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1016/0029-7844(96)00033-6

To determine if an additive effect exists between antenatal corticosteroid administration and postnatal surfactant therapy in the prevention of respiratory distress syndrome (RDS) in preterm infants.
A randomized, double-blind trial was conducted from April 1990 to June 1994, in which dexamethasone (5 mg every 12 hours for a total of four doses) or saline was given to women at risk for delivery at 24–29 weeks' gestation. At birth, prophylactic surfactant was administered to all study infants. Main outcome measures were RDS occurrence and severity: Secondary clinical end points included bronchopulmonary dysplasia, pneumothorax, patent ducrus arteriosus, necrotizing enterocolitis, retinopathy, intraventricular hemorrhage, and death.
Seventy-five of the 124 randomized subjects delivered 96 infants within the studied gestational age range (dexamethasone, n = 54; placebo, n = 42). Similar maternal demographics and obstetric complications were noted between study groups. A greater proportion of infants were delivered from multi-fetal gestations in the dexamethasone cohort (26 of 54 versus 12 of 42 newborns; P = .05). There were no significant differences in the occurrence or severity of RDS between the dexamethasone and placebo infants (none or mild, 67 versus 67%; moderate, 24 versus 26%; severe, 9 versus 7%, respectively), or differences in any of the secondary clinical outcomes. The study size was sufficient to exclude a 50% reduction in RDS incidence as a consequence of dexamethasone exposure. An analysis restricted to single-tons (dexamethasone, n = 28; placebo, n = 30) revealed similar overall occurrence of intraventricular hemorrhage (12 of 28 versus ten of 30; P = .63), but significantly fewer grade 3 and 4 intraventricular hemorrhages in dexamethasone-exposed neonates (two of 12 versus six of ten; P = .048).
Antenatal dexamethasone does not appear to decrease the incidence or severity of RDS in surfactant-treated infants delivered at 24–29 weeks' gestation, but may be associated with reduced severity of intraventricular hemorrhages in surfactant-treated singletons in this gestational age range.