Postnatal corticosteroid use for prevention or treatment of bronchopulmonary dysplasia in England and Wales 2012–2019: a retrospective population cohort study

Yao, Sijia; Uthaya, Sabita; Gale, Chris; Modi, Neena; Battersby, Cheryl

doi:10.1136/bmjopen-2022-063835

Cited by 14 publications

(25 citation statements)

References 36 publications

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“…These data are different from those of the EPICE cohort, showing exposure rates of 35.8% ( Shaffer et al, 2019 ), and from those reported in some US studies (up to 38% in extremely preterm infants) ( Puia-Dumitrescu et al, 2022 ). In the retrospective study of the UK Neonatal Collaborative ( Yao et al, 2022 ), the rate of PC use for the prevention or treatment of BPD was 8% in 62,019 infants born at less than 32 weeks of gestation, thus substantially lower compared to our cohort. However, despite an overlapping between the study periods, it is difficult to compare these populations, as in the UK cohort dexamethasone was predominantly used, followed by late hydrocortisone.…”

Section: Discussioncontrasting

confidence: 56%

Postnatal corticosteroid exposure in very preterm infants: A French cohort study

Iacobelli¹,

Allamèle-Moutama²,

Lorrain³

et al. 2023

Front. Pharmacol.

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Background: Postnatal corticosteroids (PC) are widely used in very preterm infants. International reports and national multicenter trials describe a marked variability across countries and inter-sites, in the use of PC. Few information is available on therapeutic indications and prescription characteristics of PC.Aim: The main objective of this study was to describe the exposure to PC in a large cohort of preterm infants born at less than 32 weeks of gestation, according to the prescription data of 41 tertiary-care NICUs in France. Secondary objectives were to describe therapeutic indications, day of life (DOL) of the first exposure, route of administration, duration, cumulative dose for each drug, and differences in exposure rates across centers.Methods: We conducted a prospective observational cohort analysis from January 2017 to December 2021, in 41 French tertiary-care NICUs using the same computerized order-entry system.Results: In total, 13,913 infants [birth weight 1144.8 (±365.6) g] were included. Among them, 3633 (26.1%) were exposed to PC, 21.8% by systemic and 10.1% by inhaled route. Within the study population, 1,992 infants (14.3%) received the first corticosteroid treatment in the first week of life and 1641 (11.8%) after DOL 7. The more frequent indications were prevention and/or treatment of bronchopulmonary dysplasia, and arterial hypotension. Hydrocortisone was the more often prescribed molecule. For systemic PC the first exposure occurred in mean at DOL 9.4 (±13.5), mean duration of treatment was 10.3 (±14.3) days, and the cumulative dose (expressed as the equivalent dose of hydrocortisone) was in median [IQR] 9.0 [5.5–28.8] mg/kg. For inhaled PC, the first exposure occurred in mean at DOL 34.1 (±19.7), and mean duration of treatment 28.5 (±24.4) days. The exposure rate ranged from a minimum of 5% to a maximum of 56% among centers, and significantly increased over the study period (p < 0.0001).Conclusion: In this French cohort of very preterm infants, around one patient out to five was exposed to PC during hospital stay in the NICU. The exposure occurred early, starting from the first week of life. Exposure rate widely varied among centers. Pharmacoepidemiology studies are useful to increase knowledge on corticosteroid utilization patterns in preterm infants.

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Section: Discussioncontrasting

confidence: 56%

Postnatal corticosteroid exposure in very preterm infants: A French cohort study

Iacobelli¹,

Allamèle-Moutama²,

Lorrain³

et al. 2023

Front. Pharmacol.

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“…Another study found no variation in the combined outcomes of death at PMA 36 weeks or occurrence of BPD, PMA at 28 days, and death at PMA 36 weeks between the allocation groups. For the incidence of BPD at 28 days PMA and 36 weeks PMA, newborns with delayed start (>21 days PMA) were more numerous than those with a moderately early start (8–21 days PMA) 8 . There are no neurodevelopmental findings for infants whose medications were started at different times.…”

Section: Applications Of Systemic Glucocorticoidsmentioning

confidence: 93%

“…For the incidence of BPD at 28 days PMA and 36 weeks PMA, newborns with delayed start (>21 days PMA) were more numerous than those with a moderately early start (8-21 days PMA). 8 There are no neurodevelopmental findings for infants whose medications were started at different times.…”

Section: Different Sg Regimensmentioning

confidence: 99%

“…In addition, systemic glucocorticoids (SG) have been reported to be associated with some short-term and long-term adverse outcomes while lowering the risk of BPD, such as neurodevelopmental problems. 7,8 Current research is focusing on whether postnatal corticosteroids should be used and how to be used effectively so that the benefits can outweigh the risks. Therefore, this review aims to summarize the existing literature and try to provide some further evidence-based suggestions for SG management in the prevention and treatment of BPD.…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, these findings have demonstrated significant variations. In addition, systemic glucocorticoids (SG) have been reported to be associated with some short‐term and long‐term adverse outcomes while lowering the risk of BPD, such as neurodevelopmental problems 7,8 . Current research is focusing on whether postnatal corticosteroids should be used and how to be used effectively so that the benefits can outweigh the risks.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

An updated review on systemic glucocorticoids in the prevention and treatment of bronchopulmonary dysplasia

Wang

Shi

2023

Pediatric Discovery

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Bronchopulmonary dysplasia (BPD) is a severe chronic pulmonary disease affecting premature infants and their families. The main pathogenesis of BPD is the abnormal inflammatory response in immature lungs, resulting in the distortion of lung development and influencing the formation of alveoli and vascular structures. Based on anti-inflammatory mechanisms, glucocorticoids may reduce the incidence and mortality of BPD in premature infants, but different types and administrations of glucocorticoids may lead to various short-term or long-term outcomes, especially the most concerning neurodevelopmental abnormalities. Dexamethasone is currently recognized as a first-choice drug for BPD, but the different administration methods may affect the efficacy and safety of the regimen. Hydrocortisone is currently considered to minimize both short-term and long-term adverse outcomes, but its effectiveness needs to be confirmed by further trials. Numerous alternative strategies have been proposed to reduce adverse reactions, such as moderate early dosing, lower cumulative doses, and individualized dosing, but the highquality evidence is still not enough. This review is trying to summarize some new developments in mechanisms of action, adverse effects, and other treatment regimens of systemic glucocorticoids for the prevention and treatment of BPD in the recent few years.

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Systemic Postnatal Corticosteroids, Bronchopulmonary Dysplasia, and Survival Free of Cerebral Palsy

Doyle,

Mainzer,

Cheong

2024

JAMA Pediatr

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ImportanceSystemic postnatal corticosteroids have been shown to reduce rates of bronchopulmonary dysplasia (BPD) in infants born preterm, but both corticosteroids and BPD are associated with cerebral palsy.ObjectiveTo describe how the association between systemic postnatal corticosteroids and survival free of cerebral palsy varies with the risk of BPD in infants born preterm, and if the association differs between dexamethasone and hydrocortisone, or with age at starting treatment.Design, Setting, and ParticipantsThis comparative effectiveness research used weighted meta-regression analysis of eligible randomized clinical trials (RCTs) of systemic postnatal corticosteroids reported from June 1989 through March 2022 that included rates of all of BPD, mortality, and cerebral palsy in neonatal intensive care units in 10 countries. Infants born preterm at risk of BPD were included. Data were analyzed from April and July 2024.InterventionsSystemic dexamethasone or hydrocortisone.Main Outcomes and MeasuresType and timing of corticosteroid, control group rate of BPD, and risk difference in survival free of cerebral palsy between corticosteroid and control arms.ResultsTwenty-six RCTs with data on 3700 randomized infants were eligible; 18 (69%) investigated dexamethasone and 8 (31%) hydrocortisone; 12 (46%) started treatment in the first week after birth. There was evidence for a differential association of the type of corticosteroid with the effect of systemic dexamethasone on survival free of cerebral palsy and the risk of BPD in control groups (interaction coefficient, 0.54; 95% CI, 0.25-0.82; P = .001). For dexamethasone, for every 10–percentage point increase in the risk of BPD, the risk difference for survival free of cerebral palsy increased by 3.74% (95% CI, 1.54 to 5.93; P = .002). Dexamethasone was associated with improved survival free of cerebral palsy at a risk of BPD greater than 70%. Conversely, dexamethasone was associated with harm at a risk of BPD less than 30%. There was some evidence for a negative association with hydrocortisone, with possible benefit with risk of BPD less than 30%. There was no strong evidence for a differential effect of timing among those treated with dexamethasone (interaction coefficient, 0.13; 95% CI, −0.04 to 0.30; P = .14).Conclusions and RelevanceThe findings suggest that dexamethasone (compared with control) was associated with improved rates of survival free of cerebral palsy in infants at high risk of BPD but should be avoided in those at low risk. A role for hydrocortisone is uncertain.

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Postnatal corticosteroid use for prevention or treatment of bronchopulmonary dysplasia in England and Wales 2012–2019: a retrospective population cohort study

Cited by 14 publications

References 36 publications

Postnatal corticosteroid exposure in very preterm infants: A French cohort study

Postnatal corticosteroid exposure in very preterm infants: A French cohort study

An updated review on systemic glucocorticoids in the prevention and treatment of bronchopulmonary dysplasia

Systemic Postnatal Corticosteroids, Bronchopulmonary Dysplasia, and Survival Free of Cerebral Palsy

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