tailieunhanh - Neonatal Formulary - part 4

Thông gió trẻ sơ sinh non vẫn còn nghiêm trọng oxy phụ thuộc ngày 7-10 sau khi sinh có nguy cơ phát triển bệnh phổi mãn tính nghiêm trọng. Trong khi cha mẹ dễ hiểu có thể muốn điều trị với dexamethasone đã cố gắng nếu nó bắt đầu trông như vấn đề bệnh phổi | Continued DEXAMETHASONE Treating chronic lung disease Ventilated preterm babies who are still seriously oxygen dependent 7-10 days after birth are at serious risk of developing chronic lung disease. While parents may understandably want treatment with dexamethasone tried if it is starting to look as though progressive lung disease problem may jeopardise survival it remains uncertain which - if any - of the following treatment strategies is best although the DART trial regimen seems as good as any at facilitating extubation. Traditional regimen 250 micrograms kg of dexamethasone base orally or IV twice a day for 7 days has been until recently the most widely used regimen. A second course is occasionally given. Durand trial regimen 100 micrograms kg of dexamethasone base IV twice a day for 3 days and then 50 micro-grams kg twice a day for 4 days a total of 1 mg kg over 7 days . DART trial regimen 60 micrograms kg of dexamethasone base twice a day IV or orally on days 1-3 40 micro-grams kg twice a day on days 4-6 20 micrograms kg twice a day on days 7-8 and 8 micrograms kg twice a day on days 9-10 a total of 712 micrograms kg over 10 days . This 10 day course can be repeated once if necessary. Treating other conditions Hypotension One 100 microgram kg dose followed if necessary by 50 microgram kg IV twice a day for 1-2 days often cures inotrope-resistant neonatal hypotension but one safety of such a strategy still requires controlled trial evaluation. Low dose hydrocortisone is also effective. Treatment for post intubation laryngeal oedema Three 200 microgram kg doses of dexamethasone base orally or IV at 8 hourly intervals preferably started 4 hours before the endotracheal tube is removed may aid extubation in babies and in older children with an oedematous or traumatised larynx . Croup Viral croup responds to a single 600 microgram kg dose of oral dexamethasone base as well as it does to an IM dose. Inhaled budesonide . is another alternative of comparable .