Hydrocortisone to treat early bronchopulmonary dysplasia in very preterm infants: study protocol for a randomized controlled trial

Abstract

Background: Bronchopulmonary dysplasia (BPD) is still a common complication in very premature infants. At present, there is no effective treatment for BPD. Glucocorticoids are drugs commonly used to prevent or treat BPD before and after birth. In very premature infants with high risk factors for BPD, early use of dexamethasone can reduce the rate of death and/or BPD but may cause long-term adverse neurodevelopmental outcomes. Hydrocortisone (HC), as an alternative drug to dexamethasone, has been increasingly used to prevent BPD. However, no study has reported the efficacy and safety of HC to treat early BPD diagnosed at postnatal day (PND) 28. Methods: This study protocol is for a multicenter double-blind randomized controlled trial of low-dose HC in the treatment of early BPD. Early BPD infants will be randomly assigned to the HC treatment group or control group. Infants in the HC group will receive 0.5 mg/kg HC twice a day for 7 days and then 0.5 mg/kg HC once a day for 3 days. The control group will be given the same volume of placebo and no intervention on the basis of routine treatment. The primary outcome is survival without moderate or severe BPD at 36 weeks postmenstrual age. Secondary outcomes are the short-and long-term effects on growth, metabolism, neurodevelopment, and other possible complications. Discussion: This trial will determine the efficacy and safety of low-dose HC administration compared to placebo for the reduction of moderate or severe BPD at 36 weeks postmenstrual age in very preterm infants with early BPD.

Effect of Continuous Nutrition Management Intervention on Nutritional Status and Development of Premature Infants Based on Mobile Medical APP

“…Therefore, the early nutrition management of premature infants is the key to improve the quality of life of premature infants. The American Academy of Pediatrics put forward the “high-risk infant-family-care” model, that is, the discharge of premature infants does not mean the end of nutritional intervention, but the beginning of a new nutritional intervention model [ 20 ]. Nutrition management intervention of premature infants is a long-term and continuous process, and regular follow-up after discharge is the focus to ensure the normal development of premature infants.…”

“…With the widespread use of smart phones, MHealth has become a research hotspot in the field of medical and health. MHealth treatment refers to the use of portable, small communication devices, or third-party applications in wireless computers to meet the health information services of doctors and patients [ 20 ]. Although the premature infants are affected by congenital factors and their development is relatively poor, they have great growth potential, especially under 1 year old [ 17 ].…”

Systematic review and meta-analysis: the effect of bronchopulmonary dysplasia on neurodevelopment in very low birth weight premature infants

“…The heterogeneity of cognitive impairment (P=0.65, I 2 =0%<50%), language impairment (P=0.20, I 2 =38%<50%), hearing loss requiring amplification (P=0.74, I 2 =0%<50%), and bilateral blindness (P=0.77, I 2 =0%<50%) were all low. There was a significant difference in cognitive impairment between the treatment group and the control group (RR =0.83, 95% CI: 0.72-0.96, P=0.01), suggesting that steroid treatment of very low birth weight preterm infants with bronchial dysplasia had a certain effect on cognition (18). Language disorder (RR =0.75, 95% CI: 0.46-1.21, P=0.24), hearing loss requiring amplification (RR =0.60, 95% CI: 0.35-1.03, P=0.06), bilateral blindness (RR =0.81, 95% CI: 0.52-1.24, P=0.32).…”

Systemic postnatal corticosteroid use for the prevention of bronchopulmonary dysplasia and its relationship to early neurodevelopment in extremely preterm infants

“…BPD was defined as the ongoing need for supplemental oxygen and/or respiratory support at or beyond 36 weeks postmenstrual age (PMA) [1]. Increased survival of extremely preterm infants and provision of active care to infants as young as 22 weeks at birth may have increased its prevalence [1,7,9,10]. While BPD is complex and multifactorial in origin, inflammation of the lungs plays a key role in its pathogenesis [4,7,[11][12][13][14].…”

“…Postnatal corticosteroids (PNC), including dexamethasone, are used in the management of BPD due to their anti-inflammatory properties. However, there is controversy regarding their impact on long-term neurodevelopment [3,4,7,10,12,[15][16][17].…”