Systemic corticosteroid regimens for prevention of bronchopulmonary dysplasia in preterm infants

Onland, Wes; Jaegere, Anne P De; Offringa, Martin; Kaam, Anton van

doi:10.1002/14651858.cd010941

Cited by 24 publications

(35 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Neurodevelopmental outcomes for each GA week adjusted for the common perinatal risk factors were determined by univariate analysis. Risk factors included for this analysis were antenatal corticosteroids, male gender, GA, birthweight <10th percentile, major IVH, late‐onset sepsis, NEC and CLD . Other known risk factors of interest (e.g.…”

Section: Methodsmentioning

confidence: 99%

Neurodevelopmental outcomes of extremely preterm infants in New South Wales and the Australian Capital Territory

Bolisetty

Tiwari

Sutton

et al. 2018

J Paediatrics Child Health

View full text Add to dashboard Cite

Aim: This study aimed to provide updated information on gestation-specific neurodevelopmental outcomes of extremely to very preterm infants 23-28 weeks' gestation admitted to neonatal intensive care units (NICUs). Methods: This was a population-based retrospective cohort study of infants born between 23 +0 and 28 +6 weeks' gestation and admitted to a network of NICUs between 2007 and 2012 in a well-defined geographic area of New South Wales (NSW) and the Australian Capital Territory (ACT). Primary outcome was moderate to severe neurodevelopmental impairment. Results: Of 2287 infants admitted to NICUs, 1914 (83.7%) survived to discharge, and 1514 (79.8% = 1514/1897) were followed up. Moderate to severe neurodevelopmental impairment was 11% overall, and the incidence decreased with increasing gestational age (GA): 25, 23, 15, 13, 9 and 7% at 23, 24, 25, 26, 27 and 28 weeks, respectively. Male gender, major intraventricular haemorrhage, late-onset sepsis, chronic lung disease and post-natal corticosteroid therapy were found to be independently associated with increased risk of moderate to severe impairment. Compared with an incidence of 16% in the 1998-2004 cohort, there was a significant reduction in moderate to severe neurodevelopmental impairment in the current cohort (unadjusted odds ratio: 0.65, 95% confidence interval: 0.52-0.80). Conclusions: We report the latest neurodevelopmental outcomes of extremely to very preterm infants in NSW and the ACT. Neurodevelopmental outcome rates based on GA alone may not provide the true estimate as these outcomes can vary based on the presence or absence of other relevant perinatal factors.

show abstract

Section: Methodsmentioning

confidence: 99%

Neurodevelopmental outcomes of extremely preterm infants in New South Wales and the Australian Capital Territory

Bolisetty

Tiwari

Sutton

et al. 2018

J Paediatrics Child Health

View full text Add to dashboard Cite

show abstract

“…A meta-analysis of RCTs comparing different doses of dexamethasone in ventilated infants <30 weeks and >7 days of age found an increased risk of BPD and also of abnormal neurodevelopment with a moderate (2 mg/kg) compared with a high-dose regimen (>4 mg/kg cumulative dose); however, the quality of the evidence was assessed as low or very low 33. These data are important as they raise the question whether a low cumulative dexamethasone dose, compared with higher doses, although intuitively preferable, is indeed the safest way to prevent BPD.…”

Section: Introductionmentioning

confidence: 99%

Prevention of bronchopulmonary dysplasia in extremely low gestational age neonates: current evidence

Poets

Lorenz

2018

Arch Dis Child Fetal Neonatal Ed

View full text Add to dashboard Cite

Bronchopulmonary dysplasia (BPD) is one of the most frequent complications in extremely low gestational age neonates, but has remained largely unchanged in rate. We reviewed data on BPD prevention focusing on recent meta-analyses. Interventions with proven effectiveness in reducing BPD include the primary use of non-invasive respiratory support, the application of surfactant without endotracheal ventilation and the use of volume-targeted ventilation in infants requiring endotracheal intubation. Following extubation, synchronised nasal ventilation is more effective than continuous positive airway pressure in reducing BPD. Pharmacologically, commencing caffeine citrate on postnatal day 1 or 2 seems more effective than a later start. Applying intramuscular vitamin A for the first 4 weeks reduces BPD, but is expensive and painful and thus not widely used. Low-dose hydrocortisone for the first 10 days prevents BPD, but was associated with almost twice as many cases of late-onset sepsis in infants born at 24-25 weeks' gestation. Inhaled corticosteroids, despite reducing BPD, were associated with a higher mortality rate. Administering dexamethasone to infants still requiring mechanical ventilation around postnatal weeks 2-3 may represent the best trade-off between restricting steroids to infants at risk of BPD while still affording high efficacy. Finally, identifying infants colonised with ureaplasma and treating those requiring intubation and mechanical ventilation with azithromycin is another promising approach to BPD prevention. Further interventions yet only backed by cohort studies include exclusive breastmilk feeding and a better prevention of nosocomial infections.

show abstract

“…In a Cochrane systematic review published in 2017, Onland et al. concluded that an optimal dosage or timing of initiation for the prevention of BPD in preterm infants could not be made based on current level of evidence . However, in 2017, Baud et al.…”

Section: Introductionmentioning

confidence: 99%

Review shows that using surfactant a number of times or as a vehicle for budesonide may reduce the risk of bronchopulmonary dysplasia

Hascoët

Jc²,

Ligi

et al. 2017

Acta Paediatrica

View full text Add to dashboard Cite

show abstract

Systemic corticosteroid regimens for prevention of bronchopulmonary dysplasia in preterm infants

Cited by 24 publications

References 43 publications

Neurodevelopmental outcomes of extremely preterm infants in New South Wales and the Australian Capital Territory

Neurodevelopmental outcomes of extremely preterm infants in New South Wales and the Australian Capital Territory

Prevention of bronchopulmonary dysplasia in extremely low gestational age neonates: current evidence

Review shows that using surfactant a number of times or as a vehicle for budesonide may reduce the risk of bronchopulmonary dysplasia

Contact Info

Product

Resources

About