Late (&gt; 7 days) postnatal corticosteroids for chronic lung disease in preterm infants

Doyle, Lex W.; Ehrenkranz, Richard A.; Halliday, Henry L.

doi:10.1002/14651858.cd001145.pub3

Cited by 98 publications

(95 citation statements)

References 103 publications

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“…[27][28][29] The importance of the associations with postnatal corticosteroids depends more on identifying survivors at risk for potentially lifelong impairments, which applies to one-third of the current cohort.…”

Section: Discussionmentioning

confidence: 99%

Biological and Social Influences on Outcomes of Extreme-Preterm/Low-Birth Weight Adolescents

Doyle¹,

et al. 2015

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BACKGROUND AND OBJECTIVES: The importance of biological versus social influences on long-term outcomes of extremely preterm children is debatable. The goal of this study was to determine the relative contributions of biological and social exposures to outcomes into adolescence in extremely preterm survivors, hypothesizing that biological exposures would be more important early, but social exposures would dominate later. METHODS: The study included 298 consecutive survivors born at <28 weeks’ gestation or weighing <1000 g in Victoria, Australia (during 1991–1992), and 262 normal birth weight (>2499 g) control subjects who were used to standardize outcomes for the preterm group. Cognitive ability was assessed at 2, 5, 8, and 18 years of age. Academic achievement was assessed at 8 and 18 years of age. RESULTS: The differences between the preterm and control groups for cognitive and academic scores remained relatively constant over time. The biological variables most associated with worse outcomes within the extremely preterm group were intraventricular hemorrhage and postnatal corticosteroid therapy. Of the social variables, being reared in a multilingual household was disadvantageous early, with social class and maternal education becoming more important for later outcomes. The strength of the biological associations mostly equaled or exceeded those of social exposures, even in late adolescence. CONCLUSIONS: Contrary to expectations, several perinatal biological exposures had large and persistent adverse associations with cognitive and academic outcomes among extremely preterm survivors. As expected, some social variables assumed increasing importance in later years but mostly did not diminish or exceed the important biological associations.

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Section: Discussionmentioning

confidence: 99%

Biological and Social Influences on Outcomes of Extreme-Preterm/Low-Birth Weight Adolescents

Doyle¹,

et al. 2015

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“…Actualmente, el tratamiento precoz (≤7 días de vida) con dexametasona e hidrocortisona no se recomienda para la prevención de la displasia broncopulmonar, ya que los beneficios de este tratamiento no superan los efectos adversos a corto y largo plazo (9)(10)(11). Por otra parte, el uso tardío de la dexametasona (>7 días) se reserva solamente para aquellos casos en los que no es posible la suspensión de la asistencia respiratoria mecánica, ocasiones en las que se utiliza siempre la menor dosis durante el menor tiempo posible (12).…”

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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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“…Following the 2 small early sequential trials of dexamethasone for ventilator-dependent infants with BPD [9,10], there have been many randomized trials of postnatal steroids given within 7 days of birth to prevent BPD [12] or after the first week of life to treat BPD [13]. Meta-analyses and systematic reviews of these trials were updated in the Cochrane Library in 2014.…”

Section: Randomized Trials Of Postnatal Steroidsmentioning

confidence: 99%

“…There are 21 trials enrolling 1,424 preterm infants in which postnatal steroids were given beyond the first week of life [13]. Meta-analyses of these trials show a reduction in neonatal mortality (RR 0.49, 95% CI 0.28-0.85) but not mortality at discharge (RR 0.86, 95% CI 0.66-1.13).…”

Section: Randomized Trials Of Postnatal Steroidsmentioning

confidence: 99%

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Update on Postnatal Steroids

Halliday¹

2017

Neonatology

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Antenatal steroid treatment to enhance fetal lung maturity and surfactant treatment to prevent or treat respiratory distress syndrome have been major advances in perinatal medicine in the past 40 years contributing to improved outcomes for preterm infants. Use of postnatal steroids to prevent or treat chronic lung disease in preterm infants has been less successful and associated with adverse neurodevelopmental outcomes. Although early (in the first week of life) postnatal steroid treatment facilitates earlier extubation and reduces the risk of chronic lung disease, it is associated with adverse effects, such as hyperglycemia, hypertension, gastrointestinal bleeding and perforation, hypertrophic cardiomyopathy, growth failure, and cerebral palsy, and cannot be recommended. Early treatment with hydrocortisone may also improve survival without chronic lung disease, but concerns remain about possible adverse effects such as gastrointestinal perforation and sepsis, particularly in very preterm infants. Early inhaled budesonide also reduces the incidence of chronic lung disease but there are concerns that this may occur at the expense of increased risk of death. More studies of early low-dose steroids with adequate long-term follow-up are needed before they can be recommended for the prevention of chronic lung disease. Late (after the first week of life) postnatal steroids may have a better benefit-to-harm ratio than early steroids. A Cochrane Review shows that late steroid treatment reduces chronic lung disease, the combination of death and chronic lung disease at both 28 days and 36 weeks' corrected age, and the need for later rescue dexamethasone. Adverse effects include hyperglycemia, hypertension, hypertrophic cardiomyopathy, and severe retinopathy of prematurity but without an increase in blindness. Long-term neurodevelopmental effects are not significantly increased by late postnatal steroid treatment. Current recommendations are that postnatal steroid treatment should be reserved for preterm infants who are ventilator-dependent after the first 7-14 days of life and any course should be low dose and of short duration to facilitate endotracheal extubation. Budesonide/surfactant mixtures show some promise as a means of reducing chronic lung disease in preterm infants with severe respiratory distress syndrome, but further larger studies with long-term follow-up are needed before this treatment can be recommended as a routine intervention.

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Late (> 7 days) postnatal corticosteroids for chronic lung disease in preterm infants

Cited by 98 publications

References 103 publications

Biological and Social Influences on Outcomes of Extreme-Preterm/Low-Birth Weight Adolescents

Biological and Social Influences on Outcomes of Extreme-Preterm/Low-Birth Weight Adolescents

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

Update on Postnatal Steroids

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