TOP 30 - Impact of Implementation of Standardized Guideline for Postnatal Dexamethasone Administration on Outcomes of Premature Neonates

Publication Number: 3759.TOP 30

Zaid M. AlHussain, Children's Hospital at LHSC Londo, ON, CA, London, ON, Canada; Soume Bhattacharya, Western University, London, ON, Canada; Abdullah Aljughaiman, KSAU-HS, Al Ahsa, Ash Sharqiyah, Saudi Arabia; Ghada AlWahbi, National Guard Hospital, Riyadh, Ar Riyad, Saudi Arabia; Kelly Mendham, London Health Sciences Centre, London, ON, Canada

Background: Bronchopulmonary dysplasia (BPD) is a major complication of extreme prematurity, linked to long-term respiratory and neurodevelopmental morbidity. Despite advances in neonatal care, rates remain high, partly due to persistent pulmonary inflammation. Postnatal dexamethasone can aid extubation and reduce BPD, but concerns about neurodevelopmental effects limit its use. Variable practices and uncertainty in patient selection persist. The Canadian Paediatric Society recommends using dexamethasone selectively in high-risk infants.

Objective: To determine whether a standardized postnatal dexamethasone guideline for infants < 29 weeks’ gestation improves survival, BPD incidence and severity, and respiratory support duration compared with pre-implementation outcomes.

Design/Methods:

Design/Methods:
This retrospective before-and-after study at a tertiary NICU compares infants < 29 weeks born before (June 2019–May 2021) and after (Dec 2021–Aug 2024) guideline implementation. A washout period (June–Nov 2021) was excluded. The quality improvement (QI) initiative standardized criteria for patient selection, timing, and dosing. Clinical and demographic data, dexamethasone details, respiratory parameters, and major morbidities were collected for both cohorts.
Outcomes:
Primary outcomes: survival, BPD incidence, and severity (mild, moderate, severe). Secondary outcomes: days on ventilation, oxygen duration, and tracheostomy. Process measures (timing, dosing, adherence) and balancing measures (antibiotic use, NEC, severe ROP, and length of stay) were evaluated.
Analysis:
Cohorts will be compared using descriptive and inferential statistics. Chi-square tests will assess categorical outcomes, and t-tests or Mann–Whitney U tests will analyze continuous data. Logistic regression will adjust for confounders such as gestational age and ventilation duration. Significance is set at p< 0.05.
Timeline:
Ethics approval (WREM 124809) is active. Data collection is complete, with validation in progress. Statistical analysis will be completed by December 2025.

Table 2
Table 1.pdfBaseline clinical and demographic characteristics in all neonates less than 29 weeks in the pre- cohort and post cohort .

Table 2
Table 2 Outcome Measures and Balancing Measures in all neonates.pdfOutcome Measures and Balancing Measures in all neonates <29 weeks who received DEX