Retrospective Analysis of Short-Term Respiratory Outcomes of Three Different Steroids Used in Clinical Practice in Intubated Preterm Infants

Abstract

Objective This study aimed to compare short-term respiratory outcomes of three steroids (dexamethasone, hydrocortisone, and methylprednisolone) to facilitate extubation by improving respiratory status in preterm infants.

Study Design This is a retrospective, single-center, cohort study of 98 intubated preterm infants ≤34^6/7 weeks' gestation, admitted to a 64-bed, level III neonatal intensive care unit at the Women & Children's Hospital of Buffalo, Buffalo, NY, between 2006 and 2012, who received a short course of low-dose steroids for lung disease after first week of life.

Results Study infants received dexamethasone (34%), hydrocortisone (44%), or methylprednisolone (22%) based on clinical team preference. By day 7 after initiation of steroids, extubation occurred in 59, 44, and 41%, respectively, in infants on dexamethasone, hydrocortisone, and methylprednisolone (p = 0.3). The mean respiratory severity score (RSS = fraction of inspired oxygen × mean airway pressure), a quantitative measure of respiratory status, decreased by 44% for all infants and by 59% in the dexamethasone group by day 7.

Conclusion Steroids improved short-term respiratory outcomes in all infants (RSS and extubation); by day 7, dexamethasone treatment was associated with the greatest decrease in RSS. Additional prospective, randomized trials of short-course low-dose steroids are warranted to substantiate these findings to guide clinical decision making and in evaluating differential steroid effects on long-term neurodevelopmental outcomes.

Keywords

bronchopulmonary dysplasia - postnatal steroids - preterm infants

Publication History

Received: 20 December 2018

Accepted: 24 June 2019

Article published online:
05 August 2019

• References

• 1 Watterberg KL. ; American Academy of Pediatrics. Committee on Fetus and Newborn. Policy statement--postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia. Pediatrics 2010; 126 (04) 800-808
• 2 Committee on Fetus and Newborn. Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants. Pediatrics 2002; 109 (02) 330-338
• 3 Abman SH, Collaco JM, Shepherd EG. et al; Bronchopulmonary Dysplasia Collaborative. Interdisciplinary care of children with severe bronchopulmonary dysplasia. J Pediatr 2017; 181: 12-28.e1
• 4 Jobe AH. Postnatal corticosteroids for bronchopulmonary dysplasia. Clin Perinatol 2009; 36 (01) 177-188
• 5 Doyle L, Davis P. Postnatal corticosteroids in preterm infants: systematic review of effects on mortality and motor function. J Paediatr Child Health 2000; 36 (02) 101-107
• 6 Barrington KJ. Postnatal steroids and neurodevelopmental outcomes: a problem in the making. Pediatrics 2001; 107 (06) 1425-1426
• 7 Stark AR, Carlo WA, Tyson JE. et al; National Institute of Child Health and Human Development Neonatal Research Network. Adverse effects of early dexamethasone treatment in extremely-low-birth-weight infants. N Engl J Med 2001; 344 (02) 95-101
• 8 Coalson JJ. Pathology of bronchopulmonary dysplasia. Semin Perinatol 2006; 30 (04) 179-184
• 9 Jobe AH. Glucocorticoids, inflammation and the perinatal lung. Semin Neonatol 2001; 6 (04) 331-342
• 10 Halliday HL, Ehrenkranz RA, Doyle LW. Delayed (>3 weeks) postnatal corticosteroids for chronic lung disease in preterm infants. Cochrane Database Syst Rev 2003; (01) CD001145
• 11 Doyle LW, Davis PG, Morley CJ, McPhee A, Carlin JB. ; DART Study Investigators. Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: a multicenter, international, randomized, controlled trial. Pediatrics 2006; 117 (01) 75-83
• 12 Doyle LW, Ehrenkranz RA, Halliday HL. Dexamethasone treatment after the first week of life for bronchopulmonary dysplasia in preterm infants: a systematic review. Neonatology 2010; 98 (04) 289-296
• 13 André P, Thébaud B, Odièvre MH. et al. Methylprednisolone, an alternative to dexamethasone in very premature infants at risk of chronic lung disease. Intensive Care Med 2000; 26 (10) 1496-1500
• 14 Walsh M, Kennedy K, Goldberg R. et al. A randomized control trial of the effect of hydrocortisone on survival without bronchopulmonary dysplasia and on neurodevelopmental outcomes at 22–26 months of age in intubated infant < 30 weeks gestational age. Identification number NCT 01353313. 2011. Accessed July 15, 2019 at: https://www.clinicaltrials.gov/ct2/show/NCT01353313
• 15 Onland W, De Jaegere AP, Offringa M, van Kaam A. Systemic corticosteroid regimens for prevention of bronchopulmonary dysplasia in preterm infants. Cochrane Database Syst Rev 2017; 1: CD010941
• 16 Gupta P, Bhatia V. Corticosteroid physiology and principles of therapy. Indian J Pediatr 2008; 75 (10) 1039-1044
• 17 Avery GB, Fletcher AB, Kaplan M, Brudno DS. Controlled trial of dexamethasone in respirator-dependent infants with bronchopulmonary dysplasia. Pediatrics 1985; 75 (01) 106-111
• 18 Ballard RA, Truog WE, Cnaan A. et al; NO CLD Study Group. Inhaled nitric oxide in preterm infants undergoing mechanical ventilation. N Engl J Med 2006; 355 (04) 343-353
• 19 Rozycki HJ, Byron PR, Elliott GR, Carroll T, Gutcher GR. Randomized controlled trial of three different doses of aerosol beclomethasone versus systemic dexamethasone to promote extubation in ventilated premature infants. Pediatr Pulmonol 2003; 35 (05) 375-383
• 20 Lin YJ, Lin CH, Wu JM, Tsai WH, Yeh TF. The effects of early postnatal dexamethasone therapy on pulmonary outcome in premature infants with respiratory distress syndrome: a two-year follow-up study. Acta Paediatr 2005; 94 (03) 310-316
• 21 van der Heide-Jalving M, Kamphuis PJ, van der Laan MJ. et al. Short- and long-term effects of neonatal glucocorticoid therapy: is hydrocortisone an alternative to dexamethasone?. Acta Paediatr 2003; 92 (07) 827-835
• 22 ter Wolbeek M, de Sonneville LM, de Vries WB. et al. Early life intervention with glucocorticoids has negative effects on motor development and neuropsychological function in 14-17 year-old adolescents. Psychoneuroendocrinology 2013; 38 (07) 975-986
• 23 Cheong JL, Burnett AC, Lee KJ. et al; Victorian Infant Collaborative Study Group. Association between postnatal dexamethasone for treatment of bronchopulmonary dysplasia and brain volumes at adolescence in infants born very preterm. J Pediatr 2014; 164 (04) 737-743
• 24 Wilson-Costello D, Walsh MC, Langer JC. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Impact of postnatal corticosteroid use on neurodevelopment at 18 to 22 months' adjusted age: effects of dose, timing, and risk of bronchopulmonary dysplasia in extremely low birth weight infants. Pediatrics 2009; 123 (03) e430-e437
• 25 Kelly EN, Shah VS, Levenbach J, Vincer M, DaSilva O, Shah PS. ; Canadian Neonatal Network and Canadian Neonatal Follow-Up Network Investigators. Inhaled and systemic steroid exposure and neurodevelopmental outcome of preterm neonates. J Matern Fetal Neonatal Med 2018; 31 (20) 2665-2672
• 26 Onland W, Offringa M, Cools F. et al. Systemic hydrocortisone to prevent bronchopulmonary dysplasia in preterm infants (the SToP-BPD study); a multicenter randomized placebo controlled trial. BMC Pediatr 2011; 11: 102
• 27 ClinicalTrials.gov . Hydrocortisone for BPD, NICHD Neonatal Research Network. Available at: https://clinicaltrials.gov/ct2/show/nct01353313 ClinicalTrials.gov Identifier: NCT01353313. Updated March 11, 2019. Accessed April 15, 2019