Corticosteroids and neonatal chronic lung disease

Abstract

There is increasing evidence that inflammation plays an important role in the pathogenesis of chronic lung disease (CLD). Systemic steroid administration reduces the concentration of inflammatory markers in tracheobronchial secretions and produces a rapid improvement in pulmonary compliance and resistance and an improvement in gas exchange in ventilator dependent infants. This improvement in lung function allows a reduction in ventilator settings and facilitates weaning from mechanical ventilation and increased inspired oxygen concentrations. Despite this rapid improvement in lung function, the use of steroids does not modify mortality or long-term outcome and it is associated with many acute side-effects and possible long-term deleterious consequences on lung and CNS development. Inhaled steroids have also been used in infants with CLD or at risk of CLD and although the reported side-effects are significantly less than with systemic therapy their effectiveness is also less obvious.

Conclusion: Steroid therapy in ventilator dependent infants reduces the duration of mechanical ventilation and oxygen therapy and may reduce the incidence of severe CLD. The use of steroids in infants with CLD does not improve survival rate or long-term neurological outcome.