Use of corticosteroids and the outcome of infants with bronchopulmonary dysplasia

Abstract

SUMMARY: Ventilator-dependent premature infants are often treated with dexamethasone. Several trials showed that steroids while improve pulmonary compliance and facilitate extubation, some treated infants may have adverse effects, such as alterations of growth curves. We conducted this retrospective study to evaluate the effects of steroids on mechanical ventilation, oxygen therapy, hospital length stay and mortality, in ventilator-dependent infants with bronchopulmonary dysplasia (BPD) (defined as the need of oxygen supplementation at 28 days of life). Twenty-six newborns with BPD were evaluated during 9 -42 days postpartum (mean = 31 days) and were divided into two groups: Group I -14 newborns that did not receive dexamethasone, and Group II -12 newborns that received dexamethasone at 14 -21 days of life. Dexamethasone was given at a dose of 0.25 mg per kilogram of body weight twice daily intravenously for 3 days, after which the dose was tapered.Results -There were no statistically significant differences in the mean length of mechanical ventilation (Group I -37 days, Group II -35 days); oxygen supplementation (Group I -16 days, Group II -29 days); hospital stay (Group I -72 days, Group II -113 days); mortality (Group I -35.7%, Group II -41.6%).At birth, Group II was lighter (BW: Group I -1154 grams ± 302, Group II -791 grams ± 165; p < 0.05) and smaller (height: Group I -37.22 cm ± 3.3, Group II -33.5 ± 2.4; p< 0.05) than Group I.At 40 weeks, there were no statistically significant differences between groups in relation to anthropometric measurements. Conclusions -The use of corticosteroids in bronchopulmonary dysplasic infants may influence the somatic growth during its use. However, after its suspension, a recovery seems to occur, suggesting that its influence could be transitory. DESCRIPTORS: Dexamethasone therapy. Bronchopulmonary dysplasia.

Effects of Corticosteroids in Very Low Birth Weight Newborns Dependent on Mechanical Ventilation

“…Mataloun et al 24 observed a decrease in growth during corticosteroid therapy in a study that used higher doses over a prolonged period; growth resumed after the suspension of treatment.…”

“…However, concomitant with favorable effects of corticosteroids in preterm infants who are dependent on mechanical ventilation, several adverse effects have also been described such as hyperglycemia, 6,[13][14][15] systemic arterial hypertension, 10,[13][14][15][16] interventricular septum hypertrophy, 5,15,17 irritability, 5 gastrointestinal perforation, 18 intensification of prematurity retinopathy , 19 suppression of the adrenal axis, 20 alteration in mineral homeostasis 21 and the bone growth, 22 postnatal growth retardation, 23,24 and an increase of infection incidence. 25 In addition to these short-term adverse effects, a higher incidence of cerebral palsy and neurological alterations have been observed in preterm newborns that received corticosteroids in the neonatal period and underwent longterm evaluation.…”

Laserterapia associada ao corticoide no tratamento de inflamação pulmonar em ratos

“…A dexametasona é a forma sintética do hormônio cortisol, sendo utilizada no tratamento de displasia pulmonar e em doenças de origem inflamatória, como rinite alérgica, e o seu princípio ativo/eficácia está na ação anti-inflamatória 22,23,24 . Entretanto, não foram encontrados na literatura, trabalhos referentes ao uso da dexametasona injetável no tratamento do enfisema pulmonar.…”

Critical analysis of the use of corticosteroids in the neonatal period

“…Além dos efeitos colaterais já discutidos, o uso de corticóide no recém-nascido pode levar a hemorragia gastrintestinal 28 , úlcera gástrica perfurada 28 , perfuração intestinal 49 , aumento do risco de infecção 17,35 , hipernatremia 17,19,28 , hipertrofia miocárdica 28,29 , pobre ganho de peso 19,28,29,83 e supressão do eixo hipotálamo-hipófise-adrenal 28 , que pode durar até 1 mês depois de suspenso o tratamento 84,85 .…”