Postnatal corticosteroids for bronchopulmonary dysplasia

Abstract

Corticosteroids are used to improve lung function in infants who are progressing toward bronchopulmonary dysplasia. Corticosteroids facilitate extubation, but there is conflicting information about adverse effects on the developing brain. An approach to minimizing risk is to use low-dose, short-duration treatments in the highest risk ventilator-dependent patients. Questions remain about which corticosteroid is the safest and how to dose that corticosteroid.

Figure 1

Idealized plasma cortisol profile for a normal fetus that delivers at 40 wks and for a preterm that delivers at 26 wks gestation. The preterm infant has lower cortisol levels at delivery than the term infant. However, following delivery, the preterm has higher cortisol levels than the fetus from 26 wks to 40 wks.

Figure 2

Meta-regression analysis of death or Cerebral Palsy (CP) relative to risk of developing BPD. The graph shows the outcomes as risk differences (RD) for death or CP for randomized controlled trials. The size of the circle reflects the size of the study. The outcomes are shown relative to the percent of infants in the control arm of each study who developed BPD. For infants at high risk of BPD, the risk difference for death or CP favors corticosteroid treatment. Reprinted with permission from Doyle, et al.