Am J Perinatol 2019; 36(S 02): S58-S62
DOI: 10.1055/s-0039-1691802
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Update on Postnatal Corticosteroids to Prevent or Treat Bronchopulmonary Dysplasia

Marco Filippone
1  Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padova, Italy
,
Daniel Nardo
1  Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padova, Italy
,
Luca Bonadies
1  Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padova, Italy
,
Sabrina Salvadori
1  Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padova, Italy
,
Eugenio Baraldi
1  Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padova, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
25 June 2019 (online)

Abstract

Bronchopulmonary dysplasia (BPD) is a major complication of premature birth that significantly affects mortality and long-term morbidity in numerous immature infants. Corticosteroids are particularly suitable for treating BPD, as lung inflammation is central to its pathogenesis. Corticosteroids have considerable, fast beneficial effects on lung function in premature infants with lung disease, but they are also associated with several serious adverse effects, which may have a detrimental impact on long-term outcome. Dexamethasone is the most often used corticosteroid for systemic administration. Despite its value in preventing and treating BPD, its use is associated with several alarming short-term effects and, worst of all, with an increased rate of cerebral palsy in the long term. Dexamethasone nonetheless remains an important therapeutic option for infants with severe lung disease beyond the second to third week of life. Hydrocortisone is an important alternative to dexamethasone, as its use does not appear to be associated with any neurotoxic effects. Its efficacy in the prevention and treatment of BPD has yet to be clearly demonstrated, however. Inhaled corticosteroids might reduce lung inflammation with fewer systemic adverse effects; however, a recent, large randomized trial showed that inhaled budesonide was associated with an excess mortality, despite its beneficial respiratory effects. In another study, instilling budesonide together with surfactant in the trachea of intubated infants with severe respiratory distress appeared safe and achieved a significant reduction in the rate of BPD at 36 postmenstrual weeks. This important finding needs to be confirmed in a larger trial currently underway.