Neonatal Drug Therapy Manual


Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Original Date: 
March 1993
Revised Date: 
February 2021
  • To improve lung function and facilitate extubation in infants requiring prolonged mechanical ventilation or supplemental oxygen
  • To reduce upper airway edema post-extubation in patients at high risk due to airway concerns
  • IV direct: over 3 - 5 minutes
  • IV intermittent infusion: over 15 - 30 minutes
  • PO


  • For Chronic Lung Disease (modified DART protocol):



Days 1 to 3

0.15 mg/kg/day divided Q12H

Days 4 to 6

0.1 mg/kg/day divided Q12H

Days 7 to 9

0.05 mg/kg/day once daily

Days 10 to 12

Switch to Hydrocortisone 7-10 mg/m2/day once daily

** Note: For all patients who have been exposed to steroid therapy, monitor for adrenal suppression and if signs and symptoms are present draw serum cortisol level and start hydrocortisone coverage


  •  For high risk extubation due to airway concerns:
    • 0.05 mg/kg/dose Q8H x 3 doses peri-extubation (e.g. one or two doses prior and one or two doses after.  First dose should be given at least 4 hours prior to scheduled extubation)
    • Higher doses may be used after consultation with ENT service
Side Effects: 
  • CNS: increased risk of cerebral palsy and neurodevelopmental delay
  • CVS:edema, hypertension, arrhythmia
  • Endocrine and metabolic: adrenal suppression, hyperglycemia, sodium/water retention, hypokalemic alkalosis, growth suppression
  • GI: gastrointestinal hemorrhage, gastrointestinal perforation
  • Miscellaneous: immunosuppression
  • Renal: glucosuria


Parameters to Monitor: 
  • BP, HR
  • Serum and urine glucose
  • Serum electrolytes
  • Adrenal function (with lengthy courses)

 ** Patients who receive more than 14 days of steroids need to follow the Steroid Weaning Protocol and have their baseline cortisol tested.

  • Long term neurodevelopmental assessment
Reconstitution and Stability: 


  • Dexamethasone 4 mg/mL (doses < 0.1 mg)
    • Take 0.25 mL (1 mg) and add to 9.75 mL of SWFI
    • Final concentration: 0.1 mg/mL
  • Dexamethasone 4 mg/mL (doses > 0.1 mg and < 1 mg)
    • Take 1 mL (4 mg) and add to 9 mL SWFI
    • Final concentration: 0.4 mg/mL
  • Dexamethasone 4 mg/mL (doses > 1 mg)
    • Take 1 mL (4 mg) and add to 3 mL SWFI
    • Final concentration: 1 mg/mL


  • Dexamethasone 10 mg/mL (doses < 0.1 mg)
    • Take 0.1 mL (1 mg) and add to 9.9 mL of 0.9% NaCl
    • Final concentration: 0.1 mg/mL
  • Dexamethasone 10 mg/mL (doses > 0.1 mg)
    • Take 0.4 mL (4 mg) and add to 9.6 mL of 0.9% NaCl
    • Final concentration: 0.4 mg/mL

- Solutions Compatible: D5W, 0.9% NaCl

- Y-site Compatible: acyclovir, dexmedetomidine, famotidine, fentanyl, fluconazole, furosemide, heparin, KCl (up to 40 mmol/L), ketamine,  milrinone, morphine, piperacillin/tazobactam, SMOF, TPN

Incompatible: hydromorphone, midazolam, pantoprazole


- Khemani RG, Randolph A, Markovitz B. Corticosteroids for the prevention and treatment of post-extubation stridor in neonates, children and adults. Cochrane Database Syst Rev. 2009 Jul 8;2009(3):CD001000. doi: 10.1002/14651858.CD001000.pub3. PMID

- Doyle LW, Davis PG, Morley CJ, McPhee A, Carlin JB; DART Study Investigators.  Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: a multicenter, international, randomized, controlled trial. Pediatrics. 2006 Jan; 117 (1): 75-83

- Couser RJ, Ferrara TB, Falde B, Johnson K, Schilling CG, Hoekstra RE. Effectiveness of dexamethasone in preventing extubation failure in preterm infants at increased risk for airway edema. J Pediatr. 1992 Oct;121(4):591-6. doi: 10.1016/s0022-3476(05)81154-0. PMID: 1403397.

- Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 22nd Edition. Hudson: Lexi-Comp Inc.; 2015

- American Society on Health-System Pharmacists (ASHP). Handbook on Injectable Drugs. 19th Edition. Bethesda: American Society of Health-System Pharmacists; 2017

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