Analysis of adverse reactions to low-dose dexamethasone in bronchopulmonary dysplasia of extremely premature infants: a retrospective study

Abstract Background Bronchopulmonary dysplasia (BPD) represents a prevalent complication among extremely premature infants. Nonetheless, the optimal dosage, treatment duration, and safety profile of dexamethasone require further validation through clinical research. This study investigates the efficacy and safety of low-dose dexamethasone intervention for BPD in extremely preterm infants and establishes an evidence-based foundation for monitoring adverse drug reactions within this population. Methods A retrospective analysis was conducted on 68 cases of extremely preterm infants between March 2016 and January 2024. Among them, 41 cases received dexamethasone treatment (dexamethasone group) while 27 cases did not (control group). The control group received standard respiratory support, nutritional support, anti-infection measures, and other conventional treatments, whereas the dexamethasone group received low-dose dexamethasone in addition to standard care. The primary outcome was a composite endpoint of severe BPD or in-hospital death. Multivariable binary logistic regression was performed adjusting for gestational age, birth weight, and respiratory severity score (RSS). The study compared the extubation success rate, severe BPD incidence, and adverse reactions between the two groups. Results After adjustment for gestational age, birth weight, and RSS, dexamethasone was associated with lower odds of the composite endpoint of severe BPD or death (adjusted OR = 0.26, 95%CI 0.09–0.55, P = 0.003) and severe BPD among survivors (adjusted OR = 0.27, 95%CI 0.10–0.59, P = 0.005), and higher odds of extubation success (adjusted OR = 2.88, 95%CI 1.20–7.57, P = 0.024). Hyperglycaemia occurred more frequently in the dexamethasone group (41.5% vs. 18.5%, adjusted OR = 2.04, 95%CI 0.82–4.97, P = 0.121), although the difference did not reach statistical significance. Conclusion In this single-center retrospective cohort, low-dose dexamethasone was associated with lower odds of severe BPD or death and higher odds of extubation success after adjustment for gestational age, birth weight, and respiratory severity. Clinically relevant increases in adverse events, particularly hyperglycaemia, cannot be excluded given the limited sample size. Long-term growth was not assessed. These findings require validation in larger multicenter prospective studies.