Post-natal corticosteroid use

Williams, Olivia; Greenough, Anne

doi:10.1007/s00431-003-1273-0

Cited by 10 publications

(15 citation statements)

References 21 publications

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“…In addition, postnatal steroids are given to those considered at highest risk, i.e. those who remain ventilator dependent (42) Thus, in at least the majority of infants at very high risk of developing BPD and at an age when they are actively being considered for treatment with systemically administered corticosteroids, ETCO measurements can be made.…”

Section: Discussionmentioning

confidence: 99%

End-tidal Carbon Monoxide Levels in Prematurely Born Infants Developing Bronchopulmonary Dysplasia

et al. 2007

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Bronchopulmonary dysplasia (BPD) is associated with an early inflammatory response that persists after the first week of life. Inflammatory mediators can induce hemoxygenase-1 with a consequent increase in carbon monoxide (CO) production. End-tidal CO (ETCO) levels would be elevated in infants developing BPD. Serial measurements of ETCO levels were attempted on d 3, 5, 7, 14, 21, and 28 in 50 prematurely born infants (median gestational age 29 wk). Fourteen infants developed BPD [oxygen dependent beyond 36 wk post-menstrual age (PMA)] and had higher ETCO levels compared with the rest of the cohort on d 7, 14, 21, and 28. On d 14, the mean (SD) ETCO levels of the BPD group were 3.19 (1.11) ppm and 1.43 (0.61) ppm in the non-BPD group (p Ͻ 0.001). An ETCO level on d 14 Ͼ2.15 ppm had a sensitivity of 80% and specificity of 92% in predicting oxygen dependency at 36 wk PMA. Measurement of ETCO levels in prematurely born infants may be useful in the prediction of BPD.

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Section: Discussionmentioning

confidence: 99%

End-tidal Carbon Monoxide Levels in Prematurely Born Infants Developing Bronchopulmonary Dysplasia

et al. 2007

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“…36 Twenty-one percent of British consultant pediatricians reported administering PNSs after the first week of life to ventilated neonates. 37 There have been many commentaries regarding the most appropriate use or nonuse of PNSs. 10 Barrington 31 reviewed 8 reports describing longer-term outcomes of infants enrolled in prospective trials of PNSs to prevent or treat BPD/CLD.…”

Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of Postnatal Steroid Administration: A 1-Year Experience From the California Perinatal Quality Care Collaborative

Finer

Powers²,

et al. 2006

Pediatrics

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OBJECTIVE. Postnatal steroids (PNSs) are used frequently to prevent or treat chronic lung disease (CLD) in the very low birth weight (VLBW) infant, and their use continues despite concerns regarding an increased incidence of longer-term neurodevelopmental abnormalities in such infants. More recently, there has been a suggestion that corticosteroids may be a useful alternative therapy for hypotension in VLBW infants, but there have been no prospective reports of such use for a current cohort of VLBW infants. METHODS. The California Perinatal Quality Care Collaborative (CPQCC) requested members to supplement their routine Vermont Oxford Network data collection with additional information on any VLBW infant treated during their hospital course with PNS, for any indication. The indication, actual agent used, total initial daily dose, age at treatment, type of respiratory support, mean airway pressure, fraction of inspired oxygen, and duration of first dosing were recorded. RESULTS. From April 2002 to March 2003 in California, 22 of the 62 CPQCC hospitals reported supplemental data, if applicable, from a cohort of 1401 VLBW infants (expanded data group [EDG]), representing 33.2% of the VLBW infants registered with the CPQCC during the 12-month period. PNSs for CLD were administered to 8.2% of all VLBW infants in 2003, 8.6% of infants in the 42 hospitals that did not submit supplemental data (routine data-set group, compared with 7.6% in EDG hospitals). Of the 1401 VLBW infants in the EDG, 19.3% received PNSs; 3.6% received PNSs for only CLD, 11.8% for only non-CLD indications, and 4.0% for both indications. At all birth weight categories, non-CLD use was significantly greater than CLD use. The most common non-CLD indication was hypotension, followed by extubation stridor, for which 36 (16.3%) infants were treated. For hypotension, medications used were hydrocortisone followed by dexamethasone. Infants treated with PNSs exclusively for hypotension had a significantly higher incidence of intraventricular hemorrhage, periventricular leukomalacia, and death when compared with infants treated only for CLD or those who did not receive PNSs. CONCLUSIONS. The common early use of hydrocortisone for hypotension and the high morbidity and mortality in children receiving such treatment has not been recognized previously and prospective trials evaluating the short- and long-term risk/benefit of such treatment are urgently required.

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“…In contrast, other groups using lower doses (Matheny et al, 2004;Mei et al, 2004;Perloff et al, 2004) did not observe a clinically relevant induction of P-gp. We therefore believe that data presented in this communication are also relevant for the multiple dosing scenario and suggest that a potential reason for the neurotoxic effects (O'Shea et al, 1999;Yeh et al, 1998Yeh et al, , 2004Murphy et al, 2001;Nicholl et al, 2002;Williams and Greenough, 2003;Halliday, 2004) seen in preterm babies might be related to an undeveloped BBB. …”

Section: Downloaded Frommentioning

confidence: 81%

“…Murphy et al (2001) have shown that dexamethasone, the most widely used corticosteroid in premature infants, is associated with a significant decrease in cerebral cortical gray matter volume. As a result, concern has been voiced as to whether postnatal therapy with systemically administered dexamethasone is justified (Nicholl et al, 2002;Williams and Greenough, 2003;Halliday, 2004). Although the neurological adverse effects are widely recognized, no mechanism has been postulated for the occurrence of these neurological complications.…”

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confidence: 99%

Contrary to Adult, Neonatal Rats Show Pronounced Brain Uptake of Corticosteroids

Arya¹,

DeMarco²,

Issar³

et al. 2006

Drug Metab Dispos

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ABSTRACT:Neurotoxic adverse effects after systemic corticosteroid administration are elevated in preterm infants. To test whether this might be related to an immature blood-brain barrier (BBB) that permits corticosteroids to enter the brain and induce neurotoxic effects, this study assessed the differences in brain permeability of triamcinolone acetonide after intratracheal administration to neonatal (10-to 11-day-old) and adult rats. Triamcinolone acetonide (or the phosphate prodrug in the case of neonatal rats) was administered intratracheally to neonatal rats at doses of 2.5, 25, or 50 g/kg and to adult rats at 100 g/kg. An ex vivo receptor binding assay was used to monitor the cumulative brain and liver glucocorticoid receptor occupancies over 6 h. Brain and liver receptor occupancies in neonates were similar for the 25 and 50 g/kg triamcinolone acetonide phosphate (brain/liver receptor occupancy ratio, 1.10 ؎ 0.14 and 0.87 ؎ 0.13, respectively), whereas some reduction in the brain permeability was seen at the lower dose. After intratracheal administration of 100 g/kg triamcinolone acetonide to adult rats, receptor occupancies in the brain were significantly lower (brain/ liver ratio, 0.21 ؎ 0.14; p < 0.001). The study demonstrated that glucocorticoids enter the brain of neonatal rats because of an immature BBB. The results of this study support the hypothesis that neurotoxic adverse effects in preterm infants after systemic corticosteroid administration might be related to an immature BBB.Premature birth (defined as birth between 24 -34 weeks of gestational age) continues to be a major cause of infant mortality and morbidity (Mammel et al., 1983). A majority of preterm infants are born with varying degrees of maturity of the pulmonary system. This incomplete development of the pulmonary system in premature infants mandates the use of mechanical ventilators for artificial respiratory support. The damage caused to the fragile and immature lungs by these mechanical devices predisposes the premature infant to a wide array of pulmonary disorders such as chronic lung diseases (CLD). The beneficial effects of using systemic corticosteroid therapy in the treatment and/or prevention of CLD in preterm infants have been widely documented (Georgieff et al., 1989;Groneck et al., 1993).Despite these benefits, the administration of systemic corticosteroids to preterm infants causes increased short-term and long-term adverse effects. Several clinical studies suggested a significantly higher number of infants with cerebral palsy (O'Shea et al., 1999), reduced motor function, and somatic growth after antenatal and postnatal systemic corticosteroid therapy (Yeh et al., 1998). In a follow-up study, Yeh et al. (2004) found substantial adverse effects on neuromotor and cognitive function in school children treated with postnatal dexamethasone for CLD. Murphy et al. (2001) have shown that dexamethasone, the most widely used corticosteroid in premature infants, is associated with a significant decrease in cerebral cortical gray ma...

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Post-natal corticosteroid use

Abstract: There are wide variations in corticosteroid usage. This emphasises the need to identify if there is a corticosteroid dosage regimen with a positive risk/benefit ratio.

Cited by 10 publications

References 21 publications

End-tidal Carbon Monoxide Levels in Prematurely Born Infants Developing Bronchopulmonary Dysplasia

End-tidal Carbon Monoxide Levels in Prematurely Born Infants Developing Bronchopulmonary Dysplasia

Prospective Evaluation of Postnatal Steroid Administration: A 1-Year Experience From the California Perinatal Quality Care Collaborative

Contrary to Adult, Neonatal Rats Show Pronounced Brain Uptake of Corticosteroids

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