Dexamethasone in the ventilator dependant preterm infant

Publication: 14/07/2003  --
Last review: 11/12/2018  
Next review: 11/06/2020  
Clinical Protocol
UNDER REVIEW 
ID: 203 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2018  

 

This Clinical Protocol is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Protocol For The Use Of Dexamethasone In The Ventilator Dependant Preterm Infant

Background

The recent concerns regarding the short and long‐term effects of dexamethasone has resulted in a reduction in the number of preterm infants who are given dexamethasone as an aid to weaning from the ventilator.

The national consensus appears to be that it should be reserved for those with the following characteristics.

  1. Ventilator dependent beyond 7 days post‐natal age, but usually 14.
  2. High ventilatory requirements not related to infection &/or symptomatic PDA
  3. Chest‐Xray changes consistent with early/established chronic lung disease.
  4. The clinical view that progressive deterioration leading to death is likely if treatment is withheld

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Eligibility

  1. Preterm infant (< 37 weeks)
  2. Ventilator dependant beyond 7 (but usually 14) days of age
  3. Chest x‐ray changes consistent with severe chronic lung disease
  4. Consultant opinion that progressive deterioration is likely to compromise survival.

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Dosage

Must be prescribed as dexamethasone base.

“MINIDEX”
50 micrograms per Kg per dose once daily for 10 days
then
50 micrograms per Kg per dose once daily on alternate days for 10 days (5 doses)

Plus: Ranitidine if required
If the baby is on full milk feeds additional ranitidine may not be required please discuss with consultant

Enteral - Oral / Nasogastric
<37 weeks corrected gestation - 1mg/kg twice a day
≥37 weeks corrected gestation - 1mg/kg three times a day

Slow intravenous injection
<37 weeks corrected gestation - 0.5mg/kg twice a day
≥37 weeks corrected gestation - 0.5mg/kg three times a day

A higher dose regime can be used at the discretion of the consultant:

“MAXIDEX”
200 micrograms per Kg per dose 12 hourly for 5 days
then
120 micrograms per Kg per dose 12 hourly for 5 days
then
40 micrograms per Kg per dose 12 hourly for 5 days

Plus: Ranitidine IV bolus or orally for the first 5 days, then optionally thereafter according to consultant

Enteral - Oral / Nasogastric
<37 weeks corrected gestation - 1mg/kg twice a day
≥37 weeks corrected gestation - 1mg/kg three times a day

Slow intravenous injection
<37 weeks corrected gestation - 0.5mg/kg twice a day
≥37 weeks corrected gestation - 0.5mg/kg three times a day

NOTES

  1. The total duration of treatment must be written on the drug prescription chart at the outset.
  2. Always prescribe in terms of dexamethasone base.
  3. If no response on low dose in 4 days or more consider increasing to higher dose.
  4. If no response to high dose after 7 days of treatment reduce dose as per protocol.
  5. Prolonged treatment beyond this schedule is by consultant decision only.

This protocol has been discussed with and has the support of the consultants, nursing staff and pharmacists within the Neonatal Service at Leeds Teaching Hospitals.

Provenance

Record: 203
Objective:
Clinical condition:
Target patient group: Ventilator dependant preterm infants
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

N/A


Evidence base

1. Leeds Teaching Hospitals Neonatal Formulary 2. Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: a multicenter, international, randomized, controlled trial. Doyle LW, Davis PG, Morley CJ, McPhee A, Carlin JB, and the DART study invetigators. Pediatrics 2006;117:75-83. 3.Moderately early (7-14 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants HL Halliday, RA Ehrenkranz, LW Doyle Cochrane Database of Systematic Reviews 2006 Issue 3.

Document history

LHP version 1.0

Related information

Not supplied

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