Early postnatal corticosteroids in preventing mortality and bronchopulmonary dysplasia: the pivotal importance of selecting an appropriate treated population

Abstract

This study explores the efficacy of early systematic postnatal corticosteroids (PCS) in reducing bronchopulmonary dysplasia (BPD) and mortality among preterm infants, focusing on identifying the populations most likely to benefit. Although PCS has been extensively studied for its anti-inflammatory effects in preventing BPD, the ideal target population remains unclear. This meta-analysis included 26 randomized controlled trials (RCTs) focusing exclusively on systemic intravenous PCS. Studies were stratified by baseline BPD or mortality rates in control groups (< 50%, 50-65%, and > 65%). Results indicated that PCS effectiveness in reducing BPD or mortality was significantly associated with baseline risk, with rate differences (RD) for BPD or mortality of - 0.03 (95% CI - 0.08, 0.01) in lower-risk groups (< 50%), - 0.07 (95% CI - 0.12, - 0.01) in moderate-risk groups (50-65%), and - 0.18 (95% CI - 0.32, - 0.04) in high-risk groups (> 65%). Linear logistic analysis demonstrated a significant trend, with higher baseline event rates in control groups associated with a more substantial RD (RD ~ rates in controls, R² = 0.228, p = 0.014). Both dexamethasone and hydrocortisone showed similar trends.

Conclusion: These findings underscore that the baseline event rates in the control group are potentially correlated with the efficacy of PCS in preventing BPD or mortality, offering more precise guidance beyond the general "high-risk" category and supporting baseline risk stratification for more targeted PCS therapy in clinical practice.

What is known: • Early postnatal corticosteroids (PCS) have been widely studied for their anti-inflammatory effects in preventing bronchopulmonary dysplasia (BPD) in preterm infants. • Determining the optimal target population for PCS remains challenging due to varying baseline risks and associated neurodevelopmental concerns.

What is new: • Stratifying infants by baseline BPD or mortality rates reveals that PCS shows greater efficacy in high-risk groups, particularly those with baseline event rates above 50%. • Considering baseline risk stratification represents a key direction for future clinical decision-making.

Keywords: Bronchopulmonary dysplasia (BPD); Postnatal corticosteroids (PCS); Preterm infants; Risk stratification.