Postnatal betamethasone vs dexamethasone in premature infants with bronchopulmonary dysplasia: a pilot study

Objective: As effects of glucocorticoids differ with respect to preparation, dose and duration, we hypothesized that a postnatal regimen of a low-dose, short-course betamethasone treatment had comparable efficacy and a better safety profile compared to the conventional high-dose, dexamethasone. Study Design: To test our hypothesis, we selected premature neonates with a birth weight <= 1000 g and a gestational age <= 29 weeks who were ventilated > 10 postnatal days with an FiO(2) > 0.4 and no ability to wean mechanical support for >= 3 consecutive days. These neonates either received twice daily dexamethasone 0.25mg kg(-1) per dose intravenously for 3 days tapered to 0.125 mg kg(-1) per dose for 4 days (June 1999 to December 2000) or betamethasone 0.125 mg kg(-1) per day intramuscularly once per day for 3 days (January 2001 to December 2002). Result: We found a significant reduction in FiO(2) after 3 days in both glucocorticoid treatment groups. There were no significant differences between the two treatment groups in the clinical parameters including decrease in FiO2, oxygenation index, mean airway pressure and percent extubation. Duration of ventilation, number of oxygen days and length of hospital stay were comparable in the two groups. Of particular interest, the betamethasone group showed fewer adverse effects, such as poor weight gain and high blood glucose, than the dexamethasone group. Conclusion: A short course of low-dose betamethasone has comparable efficacy and seemingly a better short-term safety profile compared to conventional dexamethasone treatment.