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. 2022 Nov 17;12(11):e063835.
doi: 10.1136/bmjopen-2022-063835.

Postnatal corticosteroid use for prevention or treatment of bronchopulmonary dysplasia in England and Wales 2012-2019: a retrospective population cohort study

Sijia Yao  1 , Sabita Uthaya  2 , Chris Gale  2 , Neena Modi  2 , Cheryl Battersby  3 ; UK Neonatal Collaborative (UKNC)
Collaborators, Affiliations

Postnatal corticosteroid use for prevention or treatment of bronchopulmonary dysplasia in England and Wales 2012-2019: a retrospective population cohort study

Sijia Yao et al. BMJ Open. .

Abstract

Objective: Describe the population of babies who do and do not receive postnatal corticosteroids for prevention or treatment of bronchopulmonary dysplasia (BPD).

Design: Retrospective cohort study using data held in the National Neonatal Research Database.

Setting: National Health Service neonatal units in England and Wales.

Patients: Babies born less than 32 weeks gestation and admitted to neonatal units from 1 January 2012 to 31 December 2019.

Main outcomes: Proportion of babies given postnatal corticosteroid; type of corticosteroid; age at initiation and duration, trends over time.

Secondary outcomes: Survival to discharge, treatment for retinopathy of prematurity, BPD, brain injury, severe necrotising enterocolitis, gastrointestinal perforation.

Results: 8% (4713/62019) of babies born <32 weeks and 26% (3525/13527) born <27 weeks received postnatal corticosteroids for BPD. Dexamethasone was predominantly used 5.3% (3309/62019), followed by late hydrocortisone 1.5%, inhaled budesonide 1.5%. prednisolone 0.8%, early hydrocortisone 0.3% and methylprednisolone 0.05%. Dexamethasone use increased over time (2012: 4.5 vs 2019: 5.8%, p=0.04). Median postnatal age of initiation of corticosteroid course was around 3 weeks for late hydrocortisone, 4 weeks for dexamethasone, 6 weeks for inhaled budesonide, 12 weeks for prednisolone and 16 weeks for methylprednisolone. Babies who received postnatal corticosteroids were born more prematurely, had a higher incidence of comorbidities and a longer length of stay.

Conclusions: In England and Wales, around 1 in 12 babies born less than 32 weeks and 1 in 4 born less than 27 weeks receive postnatal corticosteroids to prevent or treat BPD. Given the lack of convincing evidence of efficacy, challenges of recruiting to and length of time taken to conduct randomised controlled trial, our data highlight the need to monitor long-term outcomes in children who received neonatal postnatal corticosteroids.

Keywords: NEONATOLOGY; Neonatal intensive & critical care; RESPIRATORY MEDICINE (see Thoracic Medicine).

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Conflict of interest statement

Competing interests: CG is funded by the UK Medical Research Council (MRC) through a Transition Support Award. He has received support from Chiesi Pharmaceuticals to attend an educational conference; in the past 5 years, he has been investigator on received research grants from Medical Research Council, National Institute of Health Research, Canadian Institute of Health Research, Department of Health in England, Mason Medical Research Foundation, Westminster Medical School Research Trust and Chiesi Pharmaceuticals. CG chairs the National Institute for Health and Care Research (NIHR) Research for Patient Benefit London Regional Panel. CB is funded by the UK NIHR through an Advanced Fellowship Award. She is deputy chair for the NIHR Prioritisation committee for Hospital-based care. CB has received support from Chiesi Pharmaceuticals to attend educational conferences.

Figures

Figure 1
Figure 1
Flow chart of cohort who received postnatal steroids. *Babies can have more than one postnatal corticosteroid type. BPD, bronchopulmonary dysplasia.
Figure 2
Figure 2
Graph showing the use of postnatal corticosteroids over time.
Figure 3
Figure 3
A boxplot showing the median, IQR and range of first day postnatal corticosteroid administration for BPD (grouped by postnatal corticosteroid type) in babies who were born at <32 weeks gestation between 2012 and 2019 and were admitted to neonatal units in England and Wales. BPD, bronchopulmonary dysplasia.
See this image and copyright information in PMC

References

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