Extended course of prednisolone in infants with severe bronchopulmonary dysplasia

Linafelter, Alaina; Cuna, Alain; Liu, Cynthia; Quigley, Anastasia; Truog, William E.; Sampath, Venkatesh; Oschman, Alexandra

doi:10.1016/j.earlhumdev.2019.06.007

Cited by 22 publications

(20 citation statements)

References 34 publications

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“…17 Two of the three infants who required chronic NIV in our study also seemed to improve after the IV pulses of methylprednisolone. Similarly to our study, Linafeter et al 13 term remain poorly studied, 18 but in older children there is a marked variability in absorption and metabolism of oral prednisone, 19 and at the same dose, an oral course can result in a decreased bioavailability of the corticosteroid compared with an IV course. 20 Second, for infants mechanically ventilated, systemic steroids were considered life-saving measures, and high-dose IV pulses were expected to be associated with the most rapid and significant improvements.…”

Section: Discussionsupporting

confidence: 81%

“…Two of the three infants who required chronic NIV in our study also seemed to improve after the IV pulses of methylprednisolone. Similarly to our study, Linafeter et al 13 reported the outcomes of 43 infants with severe BPD requiring mechanical ventilation or NIV at a median age of 3.5 months, who received tapering course of systemic corticosteroids. Prednisone or methylprednisolone was administered either orally or IV, at a lower dose than in our study (0.5–2 mg/kg per day) and for a median duration of 67 days (range, 31–406 days).…”

Section: Discussionsupporting

confidence: 79%

“…They found a reduction in the adverse effects observed in the group who received the pulses of methylprednisolone. Similarly, we did not find a concerning impact of the pulses of methylprednisolone on the linear growth of the infants we included whereas Linafelter et al, 13 who used extended courses of oral prednisone, did observe impaired linear growth after four weeks of continuous therapy by prednisolone.…”

Section: Discussionmentioning

confidence: 51%

“…Of the 131 infants who received treatment, 82 (63%) were successfully weaned off oxygen. Linafelter et al 13 reported the use of prednisolone therapy in a population of 43 infants with severe BPD and a median age of 3.5 months. An extended course of prednisolone, with a median duration of 67 days, was associated with modest short‐term improvement in oxygenation, but impaired linear growth.…”

Section: Introductionmentioning

confidence: 99%

“…12 Of the 131 infants who received treatment, 82 (63%) were successfully weaned off oxygen. Linafelter et al 13 The objective of this study was to describe the evolution of the levels of respiratory support required by these infants with very severe BPD following the initiation of IV methylprednisolone pulses.…”

mentioning

confidence: 99%

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Intravenous pulses of methylprednisolone for infants with severe bronchopulmonary dysplasia and respiratory support after 3 months of age

Billion

Hadchouel

Garcelon

et al. 2020

Pediatric Pulmonology

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Introduction There are few published data on the efficacy of systemic corticosteroids in preterm infants with very severe forms of bronchopulmonary dysplasia (BPD), requiring respiratory support after 3 months of age. The aim of this study was to report the use of pulses of methylprednisolone in this population and its consequences on the level of respiratory support. Methods This retrospective monocentre study included infants over 3 months of age with severe BPD who received at least one pulse of methylprednisolone (300 mg/m2/day intravenous [IV] over 3 days). The primary outcome was the evolution of the pulmonary severity score (PSS) during the 3 months preceding and the 5 months following the first pulse. The evolution of the median PSS over time was analyzed using linear segmented regression for interrupted time series. Results Ten infants were included. During the 3 months preceding the first pulse, a significant increase in the median PSS was observed (p = .01), followed by a progressive decrease during the 5 months after administration of the first pulse (p < .01). Greater effects were observed in more severe infants requiring mechanical or noninvasive ventilation than in those receiving supplemental oxygen through nasal cannula. Conclusion High‐dose IV pulses of methylprednisolone were associated with a decrease in the level of respiratory support required by infants with very severe forms of BPD, with a greater effect in those on mechanical or noninvasive ventilation. Further studies are warranted to confirm these preliminary results and assess the long‐term safety of this therapy.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Intravenous pulses of methylprednisolone for infants with severe bronchopulmonary dysplasia and respiratory support after 3 months of age

Billion

Hadchouel

Garcelon

et al. 2020

Pediatric Pulmonology

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Dexamethasone, Prednisolone, and Methylprednisolone Use and 2-Year Neurodevelopmental Outcomes in Extremely Preterm Infants

et al. 2022

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IMPORTANCEPractice variability exists in the use of corticosteroids to treat or prevent bronchopulmonary dysplasia in extremely preterm infants, but there is limited information on longerterm impacts. OBJECTIVE To describe the use of corticosteroids in extremely preterm infants and evaluate the association with neurodevelopmental outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study was a secondary analysis of data from the Preterm Erythropoietin Neuroprotection (PENUT) randomized clinical trial, conducted at 19 participating sites and 30 neonatal intensive care units (NICUs) in the US. Inborn infants born

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Corticosteroid response predicts bronchopulmonary dysplasia status at 36 weeks in preterm infants treated with dexamethasone: A pilot study

Feldman

Nitkin

Cuna

et al. 2022

Pediatric Pulmonology

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Importance: A major barrier to therapeutic development in neonates is a lack of standardized drug response measures that can be used as clinical trial endpoints. The ability to quantify treatment response in a way that aligns with relevant downstream outcomes may be useful as a surrogate marker for new therapies, such as those for bronchopulmonary dysplasia (BPD).Objective: To construct a measure of clinical response to dexamethasone that was well aligned with the incidence of severe BPD or death at 36 weeks' postmenstrual age. Design: Retrospective cohort study. Setting: Level IV Neonatal Intensive Care Unit. Participants: Infants treated with dexamethasone for developing BPD between 2010 and 2020. Main Outcome(s) and Measure(s): Two models were built based on demographics, changes in ventilatory support, and partial pressure of carbon dioxide (pCO 2 ) after dexamethasone administration. An ordinal logistic regression and regularized binary logistic model for the composite outcome were used to associate response level to BPD outcomes defined by both the 2017 BPD Collaborative and 2018 Neonatal Research Network definitions. Results: Ninety-five infants were treated with dexamethasone before 36 weeks. Compared to the baseline support and demographic data at the time of treatment, changes in ventilatory support improved ordinal model sensitivity and specificity. For the binary classification, BPD incidence was well aligned with risk levels, increasing from 16% to 59%. Conclusions and Relevance: Incorporation of response variables as measured by changes in ventilatory parameters and pCO 2 following dexamethasone administration were associated with downstream outcomes. Incorporating drug response phenotype into a BPD model may enable more rapid development of future therapeutics.

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Extended course of prednisolone in infants with severe bronchopulmonary dysplasia

Cited by 22 publications

References 34 publications

Intravenous pulses of methylprednisolone for infants with severe bronchopulmonary dysplasia and respiratory support after 3 months of age

Intravenous pulses of methylprednisolone for infants with severe bronchopulmonary dysplasia and respiratory support after 3 months of age

Dexamethasone, Prednisolone, and Methylprednisolone Use and 2-Year Neurodevelopmental Outcomes in Extremely Preterm Infants

Corticosteroid response predicts bronchopulmonary dysplasia status at 36 weeks in preterm infants treated with dexamethasone: A pilot study

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