Impact of Postnatal Systemic Corticosteroids on Mortality and Cerebral Palsy in Preterm Infants: Effect Modification by Risk for Chronic Lung Disease

Abstract

The effect of postnatal corticosteroids on the combined outcome of death or CP varies with the level of risk for CLD.

Therapeutic interventions and short-term outcomes for infants with severe bronchopulmonary dysplasia born at <32 weeks’ gestation

“…12 Independent of steroid exposure, the presence of BPD itself confers a risk of adverse neurodevelopment and this risk is amplified in those with more severe BPD. 15 Thus, steroid administration in some infants may improve overall outcomes if BPD rates or severity are decreased. In an elegant meta-analysis by Doyle et al, it appeared that when risk of chronic lung disease rose above 65%, steroid use significantly reduced the risk of death or cerebral palsy, whereas the opposite effect was seen when chronic lung disease risk was less than 35%.…”

“…In high-risk cohorts with sBPD such as described here, the point at which the risk of steroid use may outweigh benefit urgently warrants further investigation so that this therapy can be used appropriately and with effectiveness. 15,27,28 This analysis also starts to define the frequency of exposure to opiates and/or BZs in the most preterm infants in this cohort, despite limited data supporting their safety or benefit in preterm infants. 29,30 Also, both human and animal models have demonstrated an adverse association with future neurodevelopment with the use of these medications.…”

“…The therapies associated with the prevention of BPD such as inhaled nitric oxide or corticosteroids have not been systematically tested in a population of infants with established sBPD in order to reduce rates of subsequent morbidities. [13][14][15] To hypothesize which therapies may offer benefit or induce harm in infants with sBPD, the characteristics of the population, their outcomes, as well as the interventions they receive must be described. 6 Moreover, descriptions of the care provided and achieved outcomes are needed to assist clinicians to counsel parents/families.…”

Heritability of Bronchopulmonary Dysplasia, Defined According to the Consensus Statement of the National Institutes of Health

“…2,3 The lack of sustained clinical benefits from late postnatal therapeutic interventions and the undesirable harmful effects of post-natal corticosteroids have fueled interest in seeking early biological markers useful in targeting therapeutic interventions aimed at promoting long-term pulmonary and neurodevelopmental benefits. 4,5 Two previous studies reported genetic influences in the etiology of BPD. The first was a family study by Parker et al, which showed a higher concordance for BPD within pairs of affected siblings.…”

Long-term cardiovascular effects of neonatal dexamethasone treatment: hemodynamic follow-up by left ventricular pressure-volume loops in rats

“…The American Academy of Pediatrics and the Canadian Pediatric Society recently published guidelines for the use of postnatal steroid treatment in preterm infants (1). With regard to the long-term effects on the brain, studies have documented adverse outcomes, including cerebral palsy and delayed and abnormal neurological development (5,6,12,18,41). The short-term cardiovascular effects after neonatal dexamethasone treatment include hypertension and hypertrophic cardiomyopathy.…”