Late (&gt; 7 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants

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

doi:10.1002/14651858.cd001145.pub4

Cited by 114 publications

(148 citation statements)

References 117 publications

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“…The authors of these studies concluded that hydrocortisone did not negatively impact neurodevelopment, was effective in increasing the chance of extubation and decreased BPD [30,31]. Similar to our study, other reports have observed a positive impact of hydrocortisone on ventilator-dependent infants, with the lack of negative effect in the neurodevelopmental outcome when started later in neonatal life [8,31].…”

Section: Discussionsupporting

confidence: 89%

“…Because BPD has been associated with presence of low cortisol levels in premature infants and ongoing inflammation due to mechanical ventilation and oxygen exposure, treatment options include corticosteroids such as hydrocortisone and dexamethasone [5,6]. However, despite several metaanalyses demonstrating the efficacy of steroid therapy facilitating extubation, concerns surrounding adverse effects, primarily on neurodevelopmental outcome, limited their use [7][8][9]. Given BPD has proven to be an independent risk factor for poor neurodevelopment, further studies evaluating lower cumulative doses of dexamethasone, administered later in neonatal life, or alternative steroid therapy have been conducted [10].…”

Section: Introductionmentioning

confidence: 99%

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Hydrocortisone and bronchopulmonary dysplasia: variables associated with response in premature infants

et al. 2020

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Objective The primary objective was to evaluate hydrocortisone's efficacy for decreasing respiratory support in premature infants with developing bronchopulmonary dysplasia (BPD). Secondary objectives included assessment of the impact of intrauterine growth restriction (IUGR), maternal history of chorioamnionitis, side effects and route of administration associated with hydrocortisone's efficacy. Dexamethasone as second-line treatment to decrease respiratory support was reviewed. Methods Retrospective chart review of preterm infants requiring respiratory support receiving hydrocortisone. Results A total of 48 patients were included. Successful extubation was achieved in 50% of intubated patients after hydrocortisone treatment with no major complications. In our small study, history of maternal chorioamnionitis, IUGR or route of administration did not affect the response. Rescue dexamethasone after hydrocortisone therapy was ineffective in the ten patients who failed extubation following hydrocortisone. Conclusion Hydrocortisone is effective in decreasing respiratory support in patients with developing BPD without major complications. Randomized studies are warranted to confirm our findings.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Hydrocortisone and bronchopulmonary dysplasia: variables associated with response in premature infants

et al. 2020

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“…Because of their antiinflammatory properties, corticosteroids have been widely used to prevent or treat BPD. In a Cochrane systematic review published in 2017, late (>7 days) postnatal systemic corticosteroid treatment for BPD was found to potentially reduce neonatal mortality without significantly increasing the risk of adverse long-term neurodevelopmental outcomes, 22 whereas late (7 days) inhaled corticosteroids treatment could not be recommended to reduce BPD in preterm infants. 23 In another review to compare the effectiveness of inhaled versus systemic corticosteroids for the treatment of BPD in ventilated VLBWIs, there was no evidence for difference in the effectiveness or adverse event profiles for inhaled versus systemic steroids.…”

Section: Discussionmentioning

confidence: 99%

Management of bronchopulmonary dysplasia in Japan: A 10-year nationwide survey

Miyake

Ito

Minami

et al. 2020

Pediatrics & Neonatology

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Background: Bronchopulmonary dysplasia (BPD) is a common complication in very preterm infants. Despite advances in perinatal medicine, the number of BPD patients is increasing in Japan. The aim of this study was to conduct a nationwide survey of the strategies used for the prevention or treatment of BPD. Methods: Questionnaires assessing the current strategies used to prevent or treat BPD, including neonatal resuscitation, drug therapy, and respiratory supportive care, were sent to secondary or tertiary perinatal units in 2015; responses were compared with those obtained from similar surveys in 2005 and 2010. The annual trend in incidence of BPD among the very low birth weight infants (VLBWIs) was determined using the Neonatal Research Network of Japan database. Results: The response rates in 2005, 2010, and 2015 were 86.8% (230/265), 64.5% (185/287), and 82.8% (236/285) of units, respectively. The use of patient-triggered ventilation for initial management significantly increased from 50% of units in 2005 to 91% in 2015. By contrast, decreased use of high-frequency oscillatory ventilation (HFOV) from 72% to 65% and that of nasal continuous positive airway pressure from 79% to 68% were reported. The proportion of units where the upper limit of targeted blood oxygen saturation before a diagnosis of BPD was set to 95% decreased substantially from 92% to 56% over the 10-year period. Despite these changes in management of BPD, the incidence of BPD among VLBWIs in Japan was increasing over a decade. Conclusion: This survey demonstrated that there were various changes in practice regarding the prevention or treatment of BPD in Japan. Continuous surveys are required to understand the current clinical situation, and research is needed to develop and evaluate a novel treatment for BPD in premature infants.

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“…The use of postnatal dexamethasone to promote lung development in preterm infants is contentious. Strong recommendations not to use postnatal steroids due to neurological risks in preterm infants to promote or protect lung development [34] have persisting influence, despite a more nuanced picture emerging from the most recent systematic reviews [3,35]. Our study suggests that 7 days of postnatal dexamethasone administered at low and high doses do not have obvious short-term effects on brain growth or damage in preterm lambs when contemporary lung-protective respiratory management strategies are used.…”

Section: Discussionmentioning

confidence: 77%

Ex Vivo MRI Analytical Methods and Brain Pathology in Preterm Lambs Treated with Postnatal Dexamethasone †

et al. 2020

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Postnatal glucocorticoids such as dexamethasone are effective in promoting lung development in preterm infants, but are prescribed cautiously due to concerns of neurological harm. We developed an analysis pipeline for post-mortem magnetic resonance imaging (MRI) to assess brain development and hence the neurological safety profile of postnatal dexamethasone in preterm lambs. Lambs were delivered via caesarean section at 129 days’ (d) gestation (full term ≈ 150 d) with saline-vehicle control (Saline, n = 9), low-dose tapered dexamethasone (cumulative dose = 0.75 mg/kg, n = 8), or high-dose tapered dexamethasone (cumulative dose = 2.67 mg/kg, n = 8), for seven days. Naïve fetal lambs (136 d gestation) were used as end-point maturation controls. The left-brain hemispheres were immersion-fixed in 10 % formalin (24 h), followed by paraformaldehyde (>6 months). Image sequences were empirically optimized for T1- and T2-weighted MRI and analysed using accessible methods. Spontaneous lesions detected in the white matter of the frontal cortex, temporo-parietal cortex, occipital lobe, and deep to the parahippocampal gyrus were confirmed with histology. Neither postnatal dexamethasone treatment nor gestation showed any associations with lesion incidence, frontal cortex (total, white, or grey matter) or hippocampal volume (all p > 0.05). Postnatal dexamethasone did not appear to adversely affect neurodevelopment. Our post-mortem MRI analysis pipeline is suitable for other animal models of brain development.

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Late (> 7 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants

Abstract: Late (> 7 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants (Review)

Cited by 114 publications

References 117 publications

Hydrocortisone and bronchopulmonary dysplasia: variables associated with response in premature infants

Hydrocortisone and bronchopulmonary dysplasia: variables associated with response in premature infants

Management of bronchopulmonary dysplasia in Japan: A 10-year nationwide survey

Ex Vivo MRI Analytical Methods and Brain Pathology in Preterm Lambs Treated with Postnatal Dexamethasone †

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