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. 2020 Apr;40(4):616-627.
doi: 10.1038/s41372-020-0594-4. Epub 2020 Feb 4.

Timing of postnatal steroids for bronchopulmonary dysplasia: association with pulmonary and neurodevelopmental outcomes

Heidi M Harmon  1 , Erik A Jensen  2 , Sylvia Tan  3 , Aasma S Chaudhary  2 , Jonathan L Slaughter  4 , Edward F Bell  5 , Myra H Wyckoff  6 , Angelita M Hensman  7 , Gregory M Sokol  8 , Sara B DeMauro  2 ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations

Timing of postnatal steroids for bronchopulmonary dysplasia: association with pulmonary and neurodevelopmental outcomes

Heidi M Harmon et al. J Perinatol. 2020 Apr.

Abstract

Objective: To determine the associations between age at first postnatal corticosteroids (PNS) exposure and risk for severe bronchopulmonary dysplasia (BPD) and neurodevelopmental impairment (NDI).

Study design: Cohort study of 951 infants born <27 weeks gestational age at NICHD Neonatal Research Network sites who received PNS between 8 days of life (DOL) and 36 weeks' postmenstrual age was used to produce adjusted odds ratios (aOR).

Results: Compared with infants in the reference group (22-28 DOL-lowest rate), aOR for severe BPD was similar for children given PNS between DOL 8 and 49 but higher among infants treated at DOL 50-63 (aOR 1.77, 95% CI 1.03-3.06), and at DOL ≥64 (aOR 3.06, 95% CI 1.44-6.48). The aOR for NDI did not vary significantly by age of PNS exposure.

Conclusion: For infants at high risk of BPD, initial PNS should be considered prior to 50 DOL for the lowest associated odds of severe BPD.

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Conflict of interest statement

Conflict of interest The authors declare that they have no conflict of interest.

Disclosures: Authors have no conflict of interest to disclose.

Figures

Figure 1:
Figure 1:
Participant flow diagram.
Figure 2:
Figure 2:
Restricted cubic spline models showing adjusted probabilities of ratios for primary outcomes (BPD, NDI) and primary outcome combined with death by categories based on age of first initiation of steroids. Dots are the adjusted probabilities of the outcome. Solid lines indicate the boundaries of the 7-age categories of steroid initiation and dashed line indicates reference group (4 weeks). Odds ratios are adjusted for private insurance status, antenatal steroids, gestation age, birthweight, small for gestational age, sex, days of high frequency and/or conventional ventilation (HFV/CV) in first week of life, fraction of inspired oxygen on day 7, and center as a fixed effect. Additionally, the NDI model was also adjusted for birth year to account for changes in the evaluation through time (changes in target age for follow-up window and addition of motor component).
Figure 3.
Figure 3.
Unadjusted rates and adjusted odds ratios for primary outcomes (BPD, NDI) and primary outcome combined with death by categories based on age of first initiation of steroids. Odds ratios are adjusted for private insurance status, antenatal steroids, gestation age, birthweight, SGA, sex, days of high frequency and/or conventional ventilation in first week of life (HFV/CV), fraction of inspired oxygen on day 7, and center as a fixed effect. Additionally, the NDI model was also adjusted for birth year to account for changes in the evaluation through time (changes in target age for follow-up window and addition of motor component).
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