dexAMETHasone

Disclaimer to the Online 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

Indication

  • A corticosteroid used to reduce airway or lung inflammation to facilitate extubation.  May also be used to prevent bronchopulmonary dysplasia (BPD) in patients assessed to be at significant risk of moderate to severe BPD.

Dosage Guidelines

Airway Edema and planned Extubation: 0.25 - 0.5 mg/kg/dose IV/ORAL q12 hours; start 12 to 24 hours prior to extubation and continue for 2 to 4 doses afterward

Prevention of Bronchopulmonary Dysplasia

  • Early Course (treatment initiated within day 8-14 of life)
    • 0.1 mg/kg/dose IV/ORAL q12 hours x 6 doses
    • 0.05 mg/kg/dose IV/ORAL q12 hours x 6 doses
    • 0.025 mg/kg/dose IV/ORAL q12 hours x 4 doses
    • 0.025 mg/kg/dose IV/ORAL q24 hours x 2 doses
  • Late Course (treatment initiated after 14 days of life)
    • 0.2 mg/kg/dose IV/ORAL q12 hours x 6 doses
    • 0.1 mg/kg/dose IV/ORAL q12 hours x 4 doses
    • 0.05 mg/kg/dose IV/ORAL q12h x 4 doses
    • 0.05 mg/kg/dose IV/ORAL q24 hours x 2 doses
    • 0.025 mg/kg/dose IV/ORAL q24 hours x 1 dose

Administration

  • IV intermittent slow infusion over 30 minutes 
  • IV direct given slowly over 3-5 minutes
  • ORAL: give with feeds to minimize gastric irritation
  • Administer at standard times of 1000h and 2200h

Adverse Effects

  • Glucose intolerance, hypertension, sinus bradycardia, irritability
  • Potiential complications include infections, growth impairment, GI bleeding, adrenal cortical suppression, adverse neurodevelopmental outcomes (doses higher than 0.5 mg/kg/day)
  • Gastrointestinal irritation; administer ORAL dose with enteral feed as able
  • Do not give concurrently with ibuprofen (increased risk of GI hemorrhage and perforation)

Comments

  • Monitor infant's weight, blood pressure and serum glucose
  • DO NOT give to infants on ibuprofen as there is a significant risk of GI bleeding and/or perforation. Ensure there is a 48-72 hour period between finishing ibuprofen and starting steroids.

Supplied As

  • 0.2mg/mL IV syringe prepared by Pharmacy for doses less than 0.8 mg
  • 4 mg/mL IV syringe, 5 mL vial for IV doses larger than 0.8 mg
  • 0.2 mg/mL or 1 mg/mL oral suspension

References

Lexicomp, Neofax, CPS July 2020 Position Statement on Postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia in preterm infants