Early (&lt; 8 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants

Doyle, Lex W.; Cheong, Jeanie L.Y.; Ehrenkranz, Richard A.; Halliday, Henry L.

doi:10.1002/14651858.cd001146.pub5

Cited by 204 publications

(214 citation statements)

References 119 publications

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“…Breaking this cycle using systemic corticosteroids is possible, and there are now over 50 randomised controlled trials studying the risks and benefits of various corticosteroid regimens [133, 134]. Dexamethasone increases the chance of successful extubation and reduces BPD but at the expense of increased risk of neurodevelopmental sequelae if used in the first week [133, 135]. We previously recommended that the smallest effective dose should be used and only for babies at highest risk of BPD such as those who remain ventilator-dependent after 1–2 weeks.…”

Section: Strategiesmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Section: Strategiesmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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“…Studies have shown that the postnatal application of systemic corticosteroids for the prevention or treatment of BPD may facilitate extubation and decrease the incidence of BPD . However, systemic corticosteroids have been linked to NDI and CP, especially in infants receiving dexamethasone during the first week after birth . To minimize the adverse effects of systemic corticosteroid administration, IAC has become a common strategy for the prevention and treatment of BPD.…”

Section: Discussionmentioning

confidence: 99%

“…36,37 However, systemic corticosteroids have been linked to NDI and CP, especially in infants receiving dexamethasone during the first week after birth. 8,11 To minimize the adverse effects of systemic corticosteroid administration, IAC has become a common strategy for the prevention and treatment of BPD. Previous studies have shown that IAC significantly reduces mucosal edema and mucus secretion, improves the gas exchange and oxygenation index, and alleviates respiratory hypersensitivity, airway resistance and the pulmonary inflammatory response.…”

Section: Main Findingsmentioning

confidence: 99%

“…Due to their strong potential anti‐inflammatory effects, anti‐inflammatory agents, such as corticosteroids, have always been the focus of prevention research . Although the systemic application of corticosteroids may reduce BPD, this approach is associated with adverse short‐ and long‐term effects, including increases in gastrointestinal perforations, the neonatal mortality rate, rehospitalization, and neurodevelopmental impairment (NDI) . Therefore, the current evidence indicates that the systemic administration of corticosteroids should not be recommended for routine use .…”

Section: Introductionmentioning

confidence: 99%

“…7 Although the systemic application of corticosteroids may reduce BPD, this approach is associated with adverse short-and long-term effects, including increases in gastrointestinal perforations, the neonatal mortality rate, rehospitalization, and neurodevelopmental impairment (NDI). [8][9][10][11] Therefore, the current evidence indicates that the systemic administration of corticosteroids should not be recommended for routine use. 12,13 As the intratracheal administration (inhalation or instillation) of corticosteroids (IAC) has strong topical effects and a rapid action onset with low doses and a lower risk of undesirable adverse effects than systemic corticosteroids, 14,15 IAC may be considered an alternative to systemic corticosteroids for the prevention of BPD in preterm infants.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term effects of the intratracheal administration of corticosteroids for the prevention of bronchopulmonary dysplasia: A meta‐analysis

Zheng

Xiu

Lin

et al. 2019

Pediatric Pulmonology

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Background Bronchopulmonary dysplasia (BPD) is one of the most common complications in premature infants. Since inflammation plays a crucial role in the pathogenesis of BPD, anti‐inflammatory drugs, such as corticosteroids, have long been the focus of prevention research. In this meta‐analysis, we aim to explore the long‐term effects of the intratracheal administration of corticosteroids (IAC) in preventing BPD. Methods EMBASE, MEDLINE, the Cochrane Library, Web of Science, CINAHL, Clinicaltrials.gov, the ISRCTN registry, and gray literature were searched to identify randomized controlled trials (RCTs) that evaluated the long‐term effects of IAC for the prevention of BPD in premature infants. Results Five RCTs (n = 1515) were eligible for further analysis. The meta‐analysis revealed that the incidence of neurodevelopmental impairment (NDI) did not significantly differ between the IAC group and the control group (relative risk [RR] 0.9, 95% confidence interval [CI] 0.79 to 1.03, P = .14). There was no significant reduction in long‐term mortality (RR, 1.13; 95% CI, 0.9 to 1.41; P = .3) or the incidence of rehospitalization (RR, 0.99; 95% CI, 0.89 to 1.09, P = .82). No significant differences were observed between the IAC group and the control group with regard to height, weight and head circumference at the age of 18 to 36 months of postmenstrual age (PMA) (mean difference [MD], 0.14; 95% CI, −0.26 to 0.54, P = .48). Conclusions Our study suggests that IAC in preterm infants does not have significant long‐term benefits or adverse outcomes. However, before routine use, well‐designed studies and studies involving large sample sizes are needed to confirm the pharmacokinetics and long‐term effects of IAC.

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Effect of Hydrocortisone Therapy Initiated 7 to 14 Days After Birth on Mortality or Bronchopulmonary Dysplasia Among Very Preterm Infants Receiving Mechanical Ventilation

Onland

Cools

Kroon

et al. 2019

JAMA

115

108

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; for the STOP-BPD Study Group IMPORTANCE Dexamethasone initiated after the first week of life reduces the rate of death or bronchopulmonary dysplasia (BPD) but may cause long-term adverse effects in very preterm infants. Hydrocortisone is increasingly used as an alternative, but evidence supporting its efficacy and safety is lacking. OBJECTIVE To assess the effect of hydrocortisone initiated between 7 and 14 days after birth on death or BPD in very preterm infants. DESIGN, SETTING, AND PARTICIPANTS Double-blind, placebo-controlled randomized trial conducted in 19 neonatal intensive care units in the Netherlands and Belgium from November 15, 2011, to December 23, 2016, among preterm infants with a gestational age of less than 30 weeks and/or birth weight of less than 1250 g who were ventilator dependent between 7 and 14 days of life, with follow-up to hospital discharge ending December 12, 2017. INTERVENTIONS Infants were randomly assigned to receive a 22-day course of systemic hydrocortisone (cumulative dose, 72.5 mg/kg) (n = 182) or placebo (n = 190). MAIN OUTCOMES AND MEASURES The primary outcome was a composite of death or BPD assessed at 36 weeks' postmenstrual age. Twenty-nine secondary outcomes were analyzed up to hospital discharge, including death and BPD at 36 weeks' postmenstrual age. RESULTS Among 372 patients randomized (mean gestational age, 26 weeks; 55% male), 371 completed the trial; parents withdrew consent for 1 child treated with hydrocortisone. Death or BPD occurred in 128 of 181 infants (70.7%) randomized to hydrocortisone and in 140 of 190 infants (73.7%) randomized to placebo (adjusted risk difference, −3.6% [95% CI, −12.7% to 5.4%]; adjusted odds ratio, 0.87 [95% CI, 0.54-1.38]; P = .54). Of 29 secondary outcomes, 8 showed significant differences, including death at 36 weeks' postmenstrual age (15.5% with hydrocortisone vs 23.7% with placebo; risk difference, −8.2% [95% CI, −16.2% to −0.1%]; odds ratio, 0.59 [95% CI, 0.35-0.995]; P = .048). Twenty-one outcomes showed nonsignificant differences, including BPD (55.2% with hydrocortisone vs 50.0% with placebo; risk difference, 5.2% [95% CI, −4.9% to 15.2%]; odds ratio, 1.24 [95% CI, 0.82-1.86]; P = .31). Hyperglycemia requiring insulin therapy was the only adverse effect reported more often in the hydrocortisone group (18.2%) than in the placebo group (7.9%). CONCLUSIONS AND RELEVANCE Among mechanically ventilated very preterm infants, administration of hydrocortisone between 7 and 14 days after birth, compared with placebo, did not improve the composite outcome of death or BPD at 36 weeks' postmenstrual age. These findings do not support the use of hydrocortisone for this indication.

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Early (< 8 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants

Abstract: Early (˜8 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants.

Cited by 204 publications

References 119 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Long‐term effects of the intratracheal administration of corticosteroids for the prevention of bronchopulmonary dysplasia: A meta‐analysis

Effect of Hydrocortisone Therapy Initiated 7 to 14 Days After Birth on Mortality or Bronchopulmonary Dysplasia Among Very Preterm Infants Receiving Mechanical Ventilation

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