Susan Bowling

Respiratory compliance in preterm infants after a single rescue course of antenatal steroids: a randomized controlled trial

OBJECTIVE To compare respiratory compliance and functional residual capacity in infants randomized to a rescue course of antenatal steroids vs placebo. STUDY DESIGN Randomized, double-blinded trial. Pregnant women > or =14 days after initial antenatal steroids were randomized to rescue antenatal steroids or placebo. The primary outcomes were measurements of respiratory compliance and functional residual capacity. This study is registered with clinicaltrials.gov (NCT00669383). RESULTS Forty-four mothers (56 infants) received rescue antenatal steroids and 41 mothers (57 infants) received placebo. There was no significant difference in birthweight, or head circumference. Infants in the rescue group had an increased respiratory compliance (1.21 vs 1.01 mL/cm H(2)O/kg; adjusted 95% confidence interval, 0.01-0.49; P = .0433) compared with placebo. 13% in the rescue vs 29% in the placebo group required > or =30% oxygen (P < .05). Patients delivered at < or =34 weeks had greater pulmonary benefits. CONCLUSION Infants randomized to rescue antenatal steroids have a significantly increased respiratory compliance compared with placebo.

Prone positioning decreases episodes of hypoxemia in extremely low birth weight infants (1000 grams or less) with chronic lung disease

Extremely low birth weight infants with chronic lung disease (CLD) have frequent episodes of desaturation (hypoxemia). We quantified oxygenation and episodes of hypoxemia in 55 infants (birth weight < or = 1000 gm) with CLD in the supine versus prone position, for 1-hour time intervals. Oxygen saturation was measured with the Nellcor N-200 pulse oximeter and a computer program. Prone positioning increased oxygen saturation from 92.0% to 94.1% (p < 0.001) and significantly decreased episodes of hypoxemia to oxygen saturation levels of less than 90%, 85%, and 80% (p < 0.001). Our findings support prone positioning for the extremely low birth weight infant with CLD in an intensive care setting.

Pulmonary function and outcomes in infants randomized to a rescue course of antenatal steroids

Our objective was to obtain follow‐up pulmonary function testing and assessment of clinical respiratory outcomes, at 1‐2 years, in preterm infants whose mothers were randomized to a single rescue course of antenatal steroids (AS) versus placebo.

Prone Positioning Improves Functional Residual Capacity (FRC), Respiratory Compliance (CRS), and Oxygenation in Intubated Preterm Infants Less Than 1250 Grams. |[dagger]| 973

Prone Positioning Improves Functional Residual Capacity (FRC), Respiratory Compliance (CRS), and Oxygenation in Intubated Preterm Infants Less Than 1250 Grams. † 973

Postnatal Dexamethasone (DEX) Increases Functional Residual Capacity (FRC) and Respiratory Compliance (CRS) in Both Preterm Females And Males

Postnatal Dexamethasone (DEX) Increases Functional Residual Capacity (FRC) and Respiratory Compliance (CRS) in Both Preterm Females And Males

Effect of Low-Dose Dexamethasone (Dex) on Respiratory Compliance in Very Low Birth Weight Infants (≤1250g): Racial Responses

Effect of Low-Dose Dexamethasone (Dex) on Respiratory Compliance in Very Low Birth Weight Infants (≤1250g): Racial Responses

Low-Dose Dexamethasone Therapy in Very Low Birth Weight (VLBW) Ventilator Dependent Infants (≤1250g): A Randomized Trial † 1073

Low-Dose Dexamethasone Therapy in Very Low Birth Weight (VLBW) Ventilator Dependent Infants (≤1250g): A Randomized Trial † 1073

Antenatal Steroids (AS) Accentuate the Increase in Functional Residual Capacity (FRC) in Very Low Birth Weight (VLBW) Infants Treated With Dexamethasone (D). † 1071

Antenatal Steroids (AS) Accentuate the Increase in Functional Residual Capacity (FRC) in Very Low Birth Weight (VLBW) Infants Treated With Dexamethasone (D). † 1071

Dexamethasone (DEX) Improves Functional Residual Capacity (FRC) and Respiratory Compliance (CRS) in Oxygen Dependent Very Low Birth Weight (VLBW) Infants: A Randomized, Blinded Trial. |[dagger]| 1072

An increasing proportion of VLBW infants developing chronic lung disease have little initial respiratory distress. In a pilot study, we documented a one week weaning course of DEX given to extubated, oxygen dependent VLBW infants to significantly increase FRC and CRS (Am Rev Respir Crit Care Med 1997;155:A235). We now report the results of a randomized, placebo controlled trial of DEX (0.5 mg/kg/day × 3 days; 0.25 mg/kg/day × 3 days; 0.1 mg/kg/day × 1 day) in VLBW infants who are extubated but oxygen dependent at greater than 5 days of age. Nine infants received DEX (mean BW=1164g; GA= 27.9 wks; FiO2=30%; age=19.9 days), while ten infants served as controls (mean BW= 1070g; GA= 28.2 wks; FiO2=31%; age=16.0 days). FRC was measured with the nitrogen washout technique. A minimum of two measurements were performed with the neonate supine and quiet. A study was acceptable if the measurements had a coefficient of variation <10%. CRS was measured using the single breath occlusion technique (SensorMedics 2600).Significantly more infants in the DEX group weaned to room air by the end of therapy. Our preliminary results demonstrate a one week course of DEX given to extubated but oxygen dependent VLBW infants significantly increases FRC (78%) and CRS(40%). We speculate that DEX may decrease the development of chronic lung disease in oxygen dependent VLBW infants. Table

CHANGES IN FUNCTIONAL RESIDUAL CAPACITY (FRC) AFTER ANTENATAL STEROID (AS) THERAPY: RACIAL RESPONSES. † 968

We have previously reported a full course of AS to significantly increase FRC in preterm infants when compared to controls (Pediatr Res 1995; 37: 224).There is no objective documentation of racial responses to AS therapy in terms of FRC and respiratory compliance (Crs). To evaluate the racial response of preterm infants to a full course of AS, we measured FRC and Crs in 15 Caucasian (CAU) infants 25 to 34 weeks of gestation (mean BW=1736g; GA= 32.3 wks; 60% female) and in 12 African American (AA) infants (mean BW = 1272 g; GA= 29.4 wks; 33% female) who had recieved two 12 mg doses of betamethasone with the first dose given at least 24 hours before, but within 7 days of delivery. Each study group was compared to a control group matched for BW, GA, and race, who had recieved no AS (15 CAU: mean BW=1829g; GA = 31.9 wks; 26% female; 12 AA: mean BW = 1270g; GA = 29.4 wks; 33% female). FRC was measured with the nitrogen washout technique within 24 hours of age, and prior to surfactant therapy if required. A minimum of two measurements were performed with the neonate supine and quiet. Only consistent tracings initated at end expiration and without evidence of a leak were accepted. A study was acceptable if the measurements had a coefficient of variation < 10%. Crs was measured using the single breath occlusion techinque (SensorMedics 2600). Values are mean± SEM. Table