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Prophylaxis of chronic lung disease after premature birth
1Division of Women's & Children's Health, Guy's King's & St Thomas' School of Medicine, King's College Hospital, London SE5 9RS, UK. anne.greenough@kcl.ac.uk
Insights
Preventing chronic lung disease in premature infants is challenging. While high-frequency ventilation and early systemic corticosteroids show promise, their long-term safety and efficacy require further investigation for vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Chronic lung disease (CLD) is a significant complication for premature infants, often resulting from neonatal intensive care interventions like volutrauma and oxygen toxicity.
- Infants born at very early gestations are particularly susceptible to developing CLD.
Purpose of the Study:
- To review prophylactic strategies for preventing CLD in premature infants.
- To evaluate the effectiveness and safety of high-frequency oscillation and early systemic corticosteroids.
Main Methods:
- Systematic review of randomized trials investigating prophylactic strategies for CLD.
- Analysis of data on clinical outcomes, including CLD incidence, mortality, intracranial pathology, pulmonary function, and neurodevelopmental outcomes.
Main Results:
- High-frequency oscillation, with a high volume strategy, may reduce CLD incidence but raises concerns about increased intracranial pathology in very immature infants.
- Early systemic corticosteroids appear to reduce CLD and mortality, but long-term pulmonary and neurodevelopmental effects warrant caution.
Conclusions:
- Current prophylactic strategies for CLD in premature infants lack definitive evidence of both efficacy and safety.
- Further research is needed to optimize ventilation strategies and understand the long-term implications of corticosteroid therapy in extremely preterm infants.
Abstract:
Chronic lung disease (CLD) following premature birth is a common adverse outcome of neonatal intensive care. It particularly occurs in infants born at very early gestations who are exposed to the dual insults of volutrauma and oxygen toxicity. Many possible prophylactic strategies have been investigated in randomized trials, but none have been demonstrated to be both effective and safe. High frequency oscillation, if a high volume strategy is pursued, reduces the incidence of CLD, but it remains unclear whether this is at the expense of an increase in intracranial pathology particularly in very immature infants. Corticosteroids administered systemically in the first two weeks after birth reduce CLD and may favourably impact on mortality; however, the long term consequences on pulmonary function and neurodevelopmental outcome of this therapy are of concern.