- 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
IV/PO
- For Chronic Lung Disease (modified DART protocol):
|
Time |
Dose |
|
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
- 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
- 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
CHEO:
- 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
TOH:
- 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