Intervention Review

Intravenous dexamethasone for extubation of newborn infants

  1. Peter G Davis1,*,
  2. David J Henderson-Smart2

Editorial Group: Cochrane Neonatal Group

Published Online: 23 OCT 2001

Assessed as up-to-date: 22 OCT 2007

DOI: 10.1002/14651858.CD000308


How to Cite

Davis PG, Henderson-Smart DJ. Intravenous dexamethasone for extubation of newborn infants. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD000308. DOI: 10.1002/14651858.CD000308.

Author Information

  1. 1

    Royal Women's Hospital, Department of Paediatrics, Parkville, Victoria, Australia

  2. 2

    Queen Elizabeth II Research Institute, NSW Centre for Perinatal Health Services Research, Sydney, NSW, Australia

*Peter G Davis, Department of Paediatrics, Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria, 3052, Australia. pgd@unimelb.edu.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 OCT 2001

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Endotracheal tubes are foreign bodies that may injure the upper airway causing laryngeal edema. This in turn may result in failure of extubation in preterm infants. Corticosteroids have been used prophylactically to reduce upper airway obstruction and facilitate extubation.

Objectives

To determine the effects of intravenous corticosteroids on the incidence of endotracheal reintubation, stridor, atelectasis and adverse side effects in newborn infants having their endotracheal tube removed following a period of intermittent positive pressure ventilation (IPPV).

Search methods

Searches were made of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) (dexamethasone and extub*), MEDLINE (MeSH search terms "dexamethasone", "extubat*" and "exp infant, newborn"), previous reviews including cross references, abstracts of conferences and symposia proceedings, expert informants and journal handsearching mainly in the English language. These searches were updated in August 2007.

Selection criteria

Trials were included that used random or quasi-random patient allocation and compared intravenous steroids given immediately prior to a planned extubation with placebo.

Data collection and analysis

Data were extracted independently by the two authors and analysed in RevMan for all trials. Prespecified subgroup analyses were performed to examine differences in response between infants at high risk for upper airway edema and those receiving routine prophylaxis prior to extubation.

Main results

Administration of dexamethasone prior to extubation significantly reduced the need for reintubation of the trachea. This result applies to both the high-risk group and to the total population of infants enrolled. However, the incidence of extubation failure was zero in the trial that attempted to exclude infants at high risk of airway edema. The side effects of higher blood sugar levels and glycosuria were found in the two trials where these were sought.

Authors' conclusions

Implications for practice
Dexamethasone reduces the need for endotracheal reintubation of neonates after a period of IPPV. In view of the lack of effect in low-risk infants and the documented and potential side effects, it appears reasonable to restrict its use to infants at increased risk for airway edema and obstruction, such as those who have received repeated or prolonged intubations.

Implications for research
Issues of dosage and applicability to the extremely low birthweight population could be addressed in future trials. Outcomes such as chronic lung disease, duration of assisted ventilation and length of hospital stay as well as long-term neurodevelopment should also be examined.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Intravenous dexamethasone for extubation of newborn infants

Dexamethasone may help babies at high risk of complications when being taken off mechanical breathing support. The tube that is placed in the baby's airway to enable mechanical ventilation (machine-assisted breathing) can cause injury. This can lead to complications when the tube is removed (extubation). This review found that giving dexamethasone (a corticosteroid drug) around the time of extubation can help prevent swelling in the baby's throat that might require reinsertion of the tube. However, the review found that there are adverse effects of dexamethasone. The benefits only outweigh the risks for babies at high risk of complication (such as those who have received several, or prolonged, intubations).

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

靜脈注射dexamethasone在新生兒拔管之使用

氣管內管對呼吸道來說屬於異物,可能會傷害上呼吸道造成喉頭水腫,在早產兒便可能造成拔管失敗;過去已預防性使用corticosteroid來減少上呼吸道阻塞及幫助拔管。

目標

決定經過一段時間間歇性正壓呼吸 (intermittent positive pressure ventilation) 後,新生兒拔管前靜脈注射類固醇是否能減少再插管、喘鳴、肺蹋陷或其他不良反應的機率。

搜尋策略

搜尋了2007年八月之前的Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) 資料庫 (使用dexamethasone和拔管搜尋) 、MEDLINE資料庫 (MeSH搜尋 ‘dexamethasone’ 、 ‘拔管’ 及 ‘exp infant, newborn’) ,以及主要以英文發表的回顧性文獻包括交叉比對,學術會議的摘要、專家意見及論文搜尋。

選擇標準

試驗包括隨機或近似隨機分配病人,比較拔管前靜脈注射類固醇及安慰劑的效果。

資料收集與分析

所有試驗資料由兩個作者獨立收集並用RevMan系統分析,上呼吸道水腫的高危險群及接受常規預防使用等次族群也被分析,以檢驗其反應的差異。

主要結論

拔管前使用dexamethasone明顯降低再插管的機率,這個結果對高危險族群及一般嬰兒均適用;然而,試圖排除高呼吸道水腫危險嬰兒的實驗中,拔管失敗的機率是零。兩個實驗發現有高血糖及尿糖的副作用。

作者結論

經過一段時間間歇性正壓呼吸的新生兒,dexamethasone的使用能減少再插管的需要。然而在低危險性嬰兒之使用並無效果,且其具有已被證實及潛在的副作用,因此限制dethamethasone只在高呼吸道水腫危險的嬰兒上使用是合理的,比如反覆插管或插管時間太久。使用的劑量以及在超低體重早產兒的適用性是未來的研究可著重的議題。長期後果如慢性肺疾病、呼吸治療的期間、住院天數以及長期神經發展也應該要研究。

翻譯人

本摘要由馬偕醫院林千裕翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

在高危險產生併發症的嬰兒脫離呼吸器支持時,使用dexamethasone可能帶來助益;呼吸器治療的氣管內管放在嬰兒呼吸道可能造成傷害,拔管時可能產生併發症。此次回顧發現預計拔管時給予dexamethasone (一種類固醇藥物) 可以預防幼兒喉嚨水腫、減少再插管;然而此次回顧也發現dexamethasone的副作用,因此只有在高危險產生併發症的幼兒才有顯著效益,如接受數次插管或插管時間太久。