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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

DEXAMETHASONE

Indications

  • the treatment of bronchopulmonary dysplasia (BPD), cerebral edema, airway edema and persistent hypoglycaemia

Pharmacology

  • dexamethasone is a synthetic glucocorticoid with potent anti-inflammatory activity; it possesses minimal mineralocorticoid effects
  • its anti-inflammatory activity may be related to stabilization of cell and lysosomal membranes, inhibition of prostaglandin and leukotriene synthesis and reduction of edema

Side Effects

  • systemic hypertension, GI upset and bleeding, glucose intolerance, possible increased susceptibility to infections, hypernatremia, hypokalemia, failure to gain weight, suppression of hypothalamus - pituitary - adrenal axis
  • long term effects, especially on growth and development, have not been carefully evaluated

Nursing Implications

  • monitor infant's weight, blood pressure, serum electrolytes, serum and urinary glucose

Dose

** RECENT LITERATURE SUGGESTS CAUTION IN THE USE OF DEXAMETHASONE BECAUSE OF POSSIBLE EFFECTS ON LONG TERM NEURODEVELOPMENT. IT IS RECOMMENDED THAT DEXAMETHASONE IS USED ONLY IN THOSE CASES WHERE THE POTENTIAL BENEFIT OUTWEIGHS THE RISKS. A LOW DOSE IS RECOMMENDED.**

- may be given IV push over 2 minutes or via slow IV administration over 30 minutes

BRONCHOPULMONARY DYSPLASIA (BPD)

  • 0.05 mg/kg IV q12h (for 3 to 5 days, depending on response)
    (may also be given as 0.1 mg/kg daily)

CEREBRAL EDEMA

  • 0.25 to 0.5 mg/kg IV Q6H

AIRWAY EDEMA

  • 0.25 mg/kg IV Q12H, (our clinical practice is 3 days before and 48 h after extubation of an infant suspected of having probable reactive airway edema)

PERSISTENT HYPOGLYCAEMIA

  • 0.25 mg/kg IV or po Q12H

Supplied

  • 0.1 mg/mL, 0.5mg/mL and 4 mg/mL syringe, prepared by Pharmacy
  • 4 mg/mL, 5 mL vial
  • 0.2mg/mL, 1 mg/mL oral solution, prepared by Pharmacy (refrigerate)

References

  1. Gomella TL (Ed): Neonatology - Management, Procedures, On-Call Problems, Diseases, Drugs, 1992, Appleton and Lange, Norwalk, Connecticut.
  2. Bhatt DR, Furman GI, Reber DJ et al: Neonatal Drug Formulary, 1990-1991, 2nd Edition, Fontana, California 92334.
  3. Knoppert DC and Mackanjee H: Current strategies in the Management of Bronchopulmonary Dysplasia - The Role of Steroids, Neonatal Network 1994;13:1-8.
  4. Mammel MC et al: Short-term dexamethasone therapy for bronchopulmonary dysplasia: Acute effects and l year followup, Developmental Pharmacology and Therapeutics 1987; 10:1-11.
  5. Cumming JJ, D'Eugenio DB and Gross SJ: A controlled trial of dexamethasone in preterm infants at high risk for bronchopulmonary dysplasia, New England Journal of Medicine 1989; 320:1505-1510.
  6. Noble - Jamieson CM, Roger R and Silverman M: Dexamethasone in neonatal chronic lung disease - pulmonary effects and intracranial complications, European Journal of Pediatrics 1989; 148:365-367.



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