Late postnatal steroid treatment using oral betamethasone can help to close ductus arteriosus in extremely preterm infants who cannot be weaned from ventilation

Late postnatal steroids are given to premature infants who cannot be weaned from ventilation because of the possible development of bronchopulmonary dysplasia (BPD). At that time, some infants still have a patent ductus arteriosus (PDA). In our experience, the use of betamethasone (BTM) seems to reduce the need for surgical/endovascular treatment of PDA. We evaluated herein the impact of oral BTM on PDA in extremely preterm infants with BPD. Extremely preterm infants (GA < 29 weeks) with PDA and treated with BTM to facilitate extubation/avoid reintubation were included in this retrospective, single-centre study. BTM was administered orally at 0.3 mg/kg/day for 3 days, 0.15 mg/kg/day the following 2 days, and 0.05 mg/kg/day on the last day. An echocardiography was performed before and after BTM treatment. The 51 infants included were born at a median [IQR] GA of 25.7 [25.0-26.7] weeks. At the time of BTM treatment (28 [26-30] days), 94.1% (48/51) were on invasive ventilation, and most (44/48, 91.7%) were extubated after BTM treatment. At that time, nearly all infants had a closed or non-haemodynamically significant PDA (50/51, 98.0%). None required surgical or endovascular treatment after BTM. Adverse effects included transient moderate hypertension (68.6%), transient hyperglycaemia (15.7%), and transient slowing of postnatal weight gain during BTM treatment.

Conclusion: In extremely preterm infants with a severe respiratory condition at 3 weeks of life, oral BTM treatment can help wean invasive ventilation and is associated with PDA closure. It could reduce the need for surgical or endovascular treatment that are associated with serious adverse effects. Trial registration: Clinicaltrials.gov NCT05987202.

What is known: • Patent ductus arteriosus and bronchopulmonary dysplasia are two most frequent complications of extreme prematurity. • Betamethasone is one of the corticosteroids used to help wean invasive ventilation in infants at risk for bronchopulmonary dysplasia.

What is new: • In extremely preterm infants still ventilated after 3 weeks of life and suffering from patent ductus arteriosus, treatment with oral betamethasone facilitated ventilatory weaning • Oral betamethasone treatment was associated with patent ductus arteriosus closure in almost all infants.