Time-Related Changes in Steroid Use and Bronchopulmonary Dysplasia in Preterm Infants

Yoder, Bradley A.; Harrison, Megan; Clark, Reese H.

doi:10.1542/peds.2008-2793

Cited by 93 publications

(72 citation statements)

References 24 publications

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“…[212][213][214] The recent meta-regression that demonstrated that corticosteroids will decrease the risk of poor neurodevelopmental outcome if an infant's baseline risk of developing BPD is Ͼ55%, along with recent updates of the Cochrane reviews, have affected our thinking. [215][216][217] 221 Confirmation of this and other new predictive tools are needed.…”

Section: Perception: the Lack Of Useful Therapies Forces Us To Revisimentioning

confidence: 99%

Targeting Inflammation to Prevent Bronchopulmonary Dysplasia: Can New Insights Be Translated Into Therapies?

2011

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Bronchopulmonary dysplasia (BPD) frequently complicates preterm birth and leads to significant long-term morbidity. Unfortunately, few therapies are known to effectively prevent or treat BPD. Ongoing research has been focusing on potential therapies to limit inflammation in the preterm lung. In this review we highlight recent bench and clinical research aimed at understanding the role of inflammation in the pathogenesis of BPD. We also critically assess currently used therapies and promising developments in the field.

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Section: Perception: the Lack Of Useful Therapies Forces Us To Revisimentioning

confidence: 99%

Targeting Inflammation to Prevent Bronchopulmonary Dysplasia: Can New Insights Be Translated Into Therapies?

2011

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“…Sin embargo, su uso se ha asociado en diversos estudios con efectos adversos a corto y largo plazo, como hipertensión arterial sistémica, hiperglucemia, retraso en el crecimiento, perforación intestinal, hemorragia digestiva, cardiomiopatía hipertrófica, infección y alteraciones en el neurodesarrollo (1)(2)(3). Por ello, en el 2002, la Canadian Paediatric Society y la American Academy of Pediatrics recomendaron evitar el uso rutinario de corticoides para la prevención y el tratamiento de la displasia pulmonar (4)(5)(6)(7)(8).…”

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Does the corticosteroid’s treatment during the pre and postnatal period affect the neurodevelopmental outcome of premature newborns?

2016

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Contribución de los autores:Marita Lardón: diseño de la investigación, recolección de datos y escritura del manuscrito Jose Uberos: diseño de la investigación, análisis de datos y revisión crítica del contenido del manuscrito Eduardo Narbona: recolección de datos, interpretación de los resultados y revisión crítica del contenido del manuscrito ¿Afecta el tratamiento con corticoides en los periodos prenatal y posnatal el neurodesarrollo del recién nacido prematuro?Marita Lardón, José Uberos, Eduardo Narbona Servicio de Pediatría, Hospital Universitario San Cecilio, Granada, EspañaIntroducción. Los glucocorticoides, ampliamente utilizados en el periodo perinatal, pueden asociarse con efectos adversos en el neurodesarrollo. Objetivo. Analizar los resultados del tratamiento con corticoides en el periodo prenatal y en el posnatal en el neurodesarrollo de una cohorte de recién nacidos de muy bajo peso. Materiales y métodos. Se hizo un estudio prospectivo de cohortes en los recién nacidos de muy bajo peso hospitalizados en la unidad de cuidados intensivos neonatales de un hospital de tercer nivel entre el 2008 y el 2013. Se comparó el neurodesarrollo entre aquellos que no recibieron tratamiento prenatal con corticoides y quienes recibieron el esquema completo (dos dosis de 12 mg de betametasona) o el incompleto (una dosis). También, se compararon los resultados en el neurodesarrollo de los recién nacidos que no recibieron tratamiento posnatal y aquellos que sí (dexametasona sistémica a partir de la primera semana de vida). Se evaluó la función motora, la neurosensorial y la cognitiva, así como los trastornos de conducta durante los dos primeros años de vida.Resultados. Se analizaron 225 recién nacidos de muy bajo peso; 83,6 % de las madres había recibido tratamiento prenatal con corticoides (esquema incompleto: 24 %; esquema completo: 59,6 %). Durante el periodo posnatal solamente el 13,3 % había recibido dexametasona sistémica. El seguimiento neurológico se llevó a cabo en 194 neonatos. En el análisis de regresión logística no se detectó que el tratamiento prenatal no el posnatal se asociara con más trastornos neurológicos, ni hubo diferencias significativas entre quienes recibieron el esquema completo y los que recibieron el incompleto durante el periodo prenatal. Conclusión. Los resultados de este estudio no pudieron demostrar que el tratamiento perinatal con corticoides se asociara con peores resultados en el neurodesarrollo en recién nacidos de muy bajo peso.Palabras clave: corticosteroides; dexametasona; betametasona; terapéutica; nacimiento prematuro; trastornos del neurodesarrollo. Materials and methods:This was a prospective cohort study in which we included all very low birth weight babies admitted to the neonatal intensive care unit of a tertiary hospital between 2008 and 2013. We compared the neurodevelopment among very low birth-weight newborns who did not receive prenatal corticosteroid therapy and those who received a complete course (two doses of 12 mg betamethasone) and an incomplete course (one dose)...

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“…While, the therapeutic efficacy of HC to treat or prevent CLD is debatable, the present studies and previous clinical reports serve to indicate that HC treatment is probably safer than Dex in the neonatal brain. Due to the concern of adverse effect on neurodevelopment, the use of Dex has dropped dramatically to ~10% of the preterm infants at risk for CLD (20), which is associated with increased rate of severe CLD (21). Current evidence strongly suggests that the benefits of early or late postnatal corticosteroid treatment, particularly Dex, may not outweigh the known or potential adverse effects of the treatment (8,22).…”

Section: Articlesmentioning

confidence: 99%

Dexamethasone but not the equivalent doses of hydrocortisone induces neurotoxicity in neonatal rat brain

et al. 2015

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Background:The use of dexamethasone (Dex) in premature infants to treat or prevent chronic lung disease adversely affects neurodevelopment. Recent clinical studies suggest that hydrocortisone (HC) is a safer alternative to Dex. We compared the effects of Dex and HC on neurotoxicity in newborn rats. Methods: Rat pups of a neurodevelopmental stage equivalent to premature human neonates were administered Dex or HC either as a single dose on postnatal day (PD) 6, repeated doses on PD 4 to 6 or tapering doses at PD 3 to 6 by i.p. injection. Brain weight, caspase-3 activity, and apoptotic cells were measured at PD 7; learning capability, memory, and motor function were measured at juvenile age. results: Dex decreased both body and brain weight gain, while HC did not. Tapering and repeated doses of Dex increased caspase-3 activity, cleaved caspase-3 and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL)-positive cells but HC, except at high doses, did not. Dex impaired learning and memory capability at juvenile age, while the rats exposed to HC showed normal cognitive behavior. conclusion: HC is probably safer to use than Dex in the immediate postnatal period in neonatal rats. Cautious extrapolation of these findings to human premature infants is required.

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Time-Related Changes in Steroid Use and Bronchopulmonary Dysplasia in Preterm Infants

Cited by 93 publications

References 24 publications

Targeting Inflammation to Prevent Bronchopulmonary Dysplasia: Can New Insights Be Translated Into Therapies?

Targeting Inflammation to Prevent Bronchopulmonary Dysplasia: Can New Insights Be Translated Into Therapies?

Does the corticosteroid’s treatment during the pre and postnatal period affect the neurodevelopmental outcome of premature newborns?

Dexamethasone but not the equivalent doses of hydrocortisone induces neurotoxicity in neonatal rat brain

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