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. 2014 Sep 5;9(9):e106838.
doi: 10.1371/journal.pone.0106838. eCollection 2014.

Utilization of inhaled corticosteroids for infants with bronchopulmonary dysplasia

Jonathan L Slaughter  1 , Michael R Stenger  1 , Patricia B Reagan  2 , Sudarshan R Jadcherla  3
Affiliations

Utilization of inhaled corticosteroids for infants with bronchopulmonary dysplasia

Jonathan L Slaughter et al. PLoS One. .

Abstract

Objective: To determine demographic and clinical variables associated with inhaled corticosteroid administration and to evaluate between-hospital variation in inhaled steroid use for infants with bronchopulmonary dysplasia (BPD).

Design: Retrospective Cohort Study.

Setting: Neonatal units of 35 US children's hospitals; as recorded in the Pediatric Health Information System (PHIS) database.

Patients: 1429 infants with evolving BPD at 28 days who were born at <29 weeks gestation with birth weight <1500 grams, admitted within the first 7 postnatal days, and discharged between January 2007-June 2011.

Results: Inhaled steroids were prescribed to 25% (n = 352) of the cohort with use steadily increasing during the first two months of hospitalization. The most frequently prescribed steroid was beclomethasone (n = 194, 14%), followed by budesonide (n = 125, 9%), and then fluticasone (n = 90, 6%). Birth gestation <24 weeks, birth weight 500-999 grams, and prolonged ventilation all increased the adjusted odds of ever receiving inhaled corticosteroids (p<0.05). Wide variations between hospitals in the frequency of infants ever receiving inhaled steroids (range: 0-60%) and the specific drug prescribed were noted. This variation persisted, even after controlling for observed confounders.

Conclusions: Inhaled corticosteroid administration to infants with BPD is common in neonatal units within U.S. Children's hospitals. However, its utilization varies markedly between centers from no treatment at some institutions to the majority of infants with BPD being treated at others. This supports the need for further research to identify the benefits and potential risks of inhaled steroid usage in infants with BPD.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Percentage of infants that ever received inhaled steroids (nebulized or MDI) during their hospital stay, by hospital.
Range: 0 to 60% (median: 12%). Hospitals were included if at least 25 patients developed BPD during the study period (N = 15).
Figure 2
Figure 2. Percentage of infants with evolving BPD having ever received inhaled corticosteroids, by day of hospitalization.
See this image and copyright information in PMC

References

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