STEROID-MEDIATED IMPROVEMENT IN NEONATAL BRONCHOPULMONARY DYSPLASIA (BPD)

In 3 Infants with BPD, aged 35 to 90 days, dramatic ventilatory improvement began within the first 24 hours of I.M. dexamethasone, 0.8 mg every 8 hours. This improvement made it possible to decrease peak inspiratory pressure an average of 9.5 cm H2O (range 7-12) within 72 hours. In 2 infants an L/S ratio was performed on tracheal aspirate obtained prior to therapy and 24, and 72 hours post-medication. The values remained essentially unchanged. One infant regressed after dexamethasone was discontinued and again improved after therapy was restarted. Two infants were successfully extubated while on dexamethasone. All 3 infants eventually succumbed, 2 to their disease and 1 to complications of dexamethasone therapy. Two additional infants with BPD also demonstrated significant improvement in ventilatory function associated with an episode of bacterial sepsis. It is hypothesized that an endogenous steroid surge may have been responsible. Both of these infants survived. The mechanism of steroid action in BPD is unknown. Induction of enzymes, other than those involved in lecithin synthesis, or a shift in fluid compartments is a theoretical possibility. Steroid therapy may be considered as a final alternative in those infants with chronic BPD who show no natural trend toward improvement.