527 - Trends in Dexamethasone Prescribing Practices for Preterm Infants from 2013 - 2023

Publication Number: 3508.527

Katherine B. Daniel, Boston Children's Hospital, Boston, MA, United States; Rachel G. Greenberg, Duke Clinical Research Institute, Durham, NC, United States; Wesley Jackson, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Matthew M. Laughon, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Samia Aleem, Duke University School of Medicine, Durham, NC, United States; Veeral Tolia, Pediatrix, Dallas, TX, United States; Bradley A.. Yoder, University of Utah, Salt Lake City, UT, United States; Samuel Gentle, Yale School of Medicine, New Haven, CT, United States

Background: Bronchopulmonary dysplasia (BPD) remains the most common morbidity of extreme prematurity for which few therapies are both safe and effective. While dexamethasone facilitates extubation and reduces the incidence of BPD in infants, existing evidence is drawn from heterogeneous dosing regimens evaluated over decades for which the optimal timing and dose remain uncertain.

Objective: To characterize dexamethasone regimens used in preterm infants hospitalized in neonatal intensive care units (NICU) from 2013-2023 and describe how those regimens change over time.

Design/Methods: Cohort study of infants born at <=32 weeks' gestation admitted to >300 NICUs and discharged between 2013 and 2023 using data available within the Pediatrix Medical Group Clinical Data Warehouse. Dexamethasone weight-based dosing and route of administration, when available, were extracted from text data for dexamethasone courses of at least 5 days' duration administered by oral or intravenous route. Clinical and demographic characteristics of dexamethasone-exposed infants were summarized. Dexamethasone courses were quantified with respect to starting daily dose (mg/kg/day), total cumulative course dose (mg/kg), course timing, and course duration and compared by route of administration. Median cumulative dexamethasone dose per course over time was visualized and evaluated using Cuzick's test for trend.

Results: Data were available for 1508 dexamethasone courses administered to 1216 infants born at <=32 weeks' gestation between 2013 and 2023. The median [IQR] gestational age and birth weight were 25w1d [24w1d-26w3d] and 681 [580-810] g, respectively (Table 1). The median [IQR] dexamethasone course length was 10 [7-12] days and started on median [IQR] postnatal day 43 [25-71] (Table 2). Median [IQR] starting dexamethasone daily dose in mg/kg/day was 0.15 [0.1-0.22], with 34% of courses <=0.15 mg/kg/day, 25% of courses >0.15 and <=0.2 mg/kg/day, and 41% >0.2 mg/kg/day. Median [IQR] total dexamethasone exposure per course in mg/kg was 1.18 [0.70-1.81]. Total prescribed dosage per course was relatively consistent across year of discharge without a significant trend (Cuzick's test p value = 0.20, Figure 1).

Conclusion(s): Dexamethasone prescribing practices were variable across NICUs. By characterizing currently employed dexamethasone regimens in preterm infants, this analysis provides foundational information to inform dosing strategies for future clinical trials of dexamethasone utilization.

Table 1. Clinical and demographic characteristics of study population.
Abbreviations: SGA, small for gestational age; LGA, large for gestational age; NICU, neonatal intensive care unit.

Table 2. Dexamethasone dosing information.
Dosage and route of administration were extracted from text data in the Pediatrix Clinical Data Warehouse. Each course's starting daily dose (mg/kg/day) and/or total course dose (mg/kg) were calculated if first day administration frequency and/or entire course dosage and frequency information were available respectively. Intravenous (IV) and oral (PO) courses were included; those for which a route of administration could not be determined are included in the overall column.

Figure 1. Comparisons of median dexamethasone exposure across neonatal intensive care unit discharge year.
Total dexamethasone exposure was calculated for each course and stratified by discharge year. Cuzick's test revealed no significant trend (p = 0.20) across this period.