Effectiveness and safety of repeat dexamethasone for bronchopulmonary dysplasia

Cuna, Alain; Quiqley, Anastasia; Varghese, Kevin; Ciccolari-Micaldi, Greta; Oliveros, Christian; Cheng, An‐Lin; Norberg, Michael; Truog, William E.

doi:10.1038/s41372-021-01125-3

Cited by 5 publications

(6 citation statements)

References 30 publications

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“…Furthermore, a longer term study has identified a greater reduction in lung function in school aged children associated with larger cumulative doses of postnatal dexamethasone in infants born at less than 29 weeks of gestation [19]. It has recently been reported that 19 to 39% of PNS-treated infants received repeated courses of PNS with varying effectiveness in facilitating a step down of respiratory support in 38-93% of infants [20][21][22]. A strength of this study is the use of a national dataset that allowed us to create an overview of premature infants born in the UK between 2014 and 2018.…”

Section: Discussionmentioning

confidence: 99%

Influence of sex on the requirement for and outcomes following late postnatal corticosteroid treatment

et al. 2023

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There remains a disparity between the outcomes of male and female prematurely born infants. Our aim was to assess the influence of sex on the requirement for late (> 7 days) postnatal corticosteroid (PNS) treatment and the outcomes following treatment. A retrospective whole population study of infants born at less than 28 weeks of gestation in all neonatal units in England between 2014 and 2018. The impact of exposure to at least five consecutive days of dexamethasone or hydrocortisone on bronchopulmonary dysplasia (BPD) at 36 weeks corrected gestation and survival to discharge from neonatal care was determined. Ten thousand, six hundred and fifty-five infants survived to seven days. Male sex was associated with an increased incidence of BPD (OR 1.41, 95%CI 1.287–1.552, p < 0.001) and death (OR 1.227, 95%CI 1.123–1.452, p < 0.001). Two thousand, three hundred and forty-four infants (22%) received at least one course of PNS at a median of 23 (IQR 15–40) days after birth. Males (23.6%) were more likely to receive PNS than females (20.1%), p < 0.001 and receive repeated courses (mean 1.67 compared to a mean of 1.59 in the females), p = 0.027. Multivariate regression analysis identified no significant differences in the incidence of BPD or death between male and females who received PNS. Conclusions: Males and females had similar outcomes after receiving PNS, but a significantly greater proportion of males met the clinical threshold to receive PNS and were more likely to receive repeated courses which may expose them to a greater risk of adverse long-term outcomes. What is Known:• There remains a difference in outcomes of male and female infants born prematurely.• Prematurely born male infants were more likely to receive postnatal corticosteroids and a greater number of courses but had similar outcomes compared to female infants. What is New:• Postnatal corticosteroids have long-term adverse effects. Such outcomes should be considered when weighing up the risk–benefit ratio of prescribing postnatal corticosteroids, particularly in very prematurely born male infants.

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Section: Discussionmentioning

confidence: 99%

Influence of sex on the requirement for and outcomes following late postnatal corticosteroid treatment

et al. 2023

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“…Preterm infants who remain on a ventilator for more than 2 weeks are considered to have a high risk of developing BPD. [ 47 ] In addition to pulmonary problems in the long term, neurodevelopmental problems, CP, cognitive deficits, and deafness can be seen in children with BPD. It is known that CP and motor abnormalities were seen when dexamethasone is used, especially in preterm infants with a low risk of BPD.…”

Section: What Should Be the Timing Of Steroid Administration? When Sh...mentioning

confidence: 99%

“…It has been reported that the second-cure steroid requirement is higher in babies with SGA and twins. [ 47 ] It was found that the success of extubation decreased in babies who received the second cure of dexamethasone treatment; while an extubation success could be achieved in the first cure around 50%, it was found that the extubation success rate in the second cure was around 35%. [ 47 ] It has been reported that there is no difference between the increase in weight, height, and head circumference when babies who receive a single cure and those who receive two cures are compared according to their anthropometric measurements at discharge.…”

Section: Second-cure Steroid Usementioning

confidence: 99%

“…[ 47 ] It was found that the success of extubation decreased in babies who received the second cure of dexamethasone treatment; while an extubation success could be achieved in the first cure around 50%, it was found that the extubation success rate in the second cure was around 35%. [ 47 ] It has been reported that there is no difference between the increase in weight, height, and head circumference when babies who receive a single cure and those who receive two cures are compared according to their anthropometric measurements at discharge. [ 47 , 57 ] However, it was observed that there was a significant difference in terms of weight, height, and head circumference between babies who received two cures and those who did not receive any steroid therapy.…”

Section: Second-cure Steroid Usementioning

confidence: 99%

“…[ 47 ] It has been reported that there is no difference between the increase in weight, height, and head circumference when babies who receive a single cure and those who receive two cures are compared according to their anthropometric measurements at discharge. [ 47 , 57 ] However, it was observed that there was a significant difference in terms of weight, height, and head circumference between babies who received two cures and those who did not receive any steroid therapy. [ 47 ]…”

Section: Second-cure Steroid Usementioning

confidence: 99%

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Role of Postnatal Corticosteroids in the Treatment or Prevention of Bronchopulmonary Dysplasia

Bülbül¹

2023

Sisli Etfal

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As the frequency of viable low birth weight preterm babies increases, bronchopulmonary dysplasia (BPD), one of the most important morbidities in these babies, also increases. Using postnatal steroids to reduce the development of BPD has not been fully enlightened. Besides all prevention strategies for reducing the development of BPD, it is known that steroid therapy used in the 1 st week of life could induce negative neuromotor development according to current data. It may be recommended to administer low-dose dexamethasone between 8 and 49 days in infants dependent on mechanical ventilators in the postnatal period. It is seen that the use of hydrocortisone in the early period does not cause negative neuromotor development, but it cannot prevent the development of BPD as much as dexamethasone. All intensive care units must have their steroid protocol for BPD and use steroids in cases when the BPD development scale score is >60–65% and should have a goal of trying to keep the cumulative dose at the lowest level.

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Glutamine inhibits inflammation, oxidative stress, and apoptosis and ameliorates hyperoxic lung injury

Zhang

Yuan

et al. 2023

J Physiol Biochem

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Effectiveness and safety of repeat dexamethasone for bronchopulmonary dysplasia

Cited by 5 publications

References 30 publications

Influence of sex on the requirement for and outcomes following late postnatal corticosteroid treatment

Influence of sex on the requirement for and outcomes following late postnatal corticosteroid treatment

Role of Postnatal Corticosteroids in the Treatment or Prevention of Bronchopulmonary Dysplasia

Glutamine inhibits inflammation, oxidative stress, and apoptosis and ameliorates hyperoxic lung injury

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