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Postnatal steroids and chronic lung disease in the newborn
1Royal Maternity Hospital and Department of Child Health, Queen's University of Belfast, Belfast, Northern Ireland. h.halliday@qub.ac.uk
Introduction:
Chronic lung disease (CLD) represents a condition of persistent inflammation within the airways which may have its origin either in utero or after birth. Corticosteroids, because of their anti- inflammatory actions, have been used to modify the course of CLD. There have been almost 40 randomised controlled trials of postnatal dexamethasone and 12 of inhaled steroids.
Methods:
Systematic reviews of randomised controlled trials of postnatal steroids (either systemic or inhaled) for CLD in the Cochrane Library were evaluated as a guide to clinical practice. Results are presented as relative risks (RR), numbers needed to treat (NNT) or harm (NNH) each with 95% confidence intervals (CI).
Results:
Postnatal dexamethasone reduces the incidence of CLD and facilitates earlier extubation but with early treatment there are serious long-term neurological adverse effects. Inhaled steroids used early (<2 wk) reduce the need for later dexamethasone (RR 0.78; 0.62-0.99 and NNT 11; 6-125). Inhaled steroids used late (>2 wk) increase the chances of extubation (RR 0.38; 0.20-0.72 and NNT 3; 2-6) and improve ventilator settings and lung mechanics. There appear to be no serious adverse effects of inhaled steroids but comparative studies suggest that dexamethasone acts more rapidly.
Conclusions:
Postnatal dexamethasone at currently recommended doses should be avoided. Lower dose dexamethasone or inhaled steroids might be indicated for ill, ventilator-dependent infants with CLD after the age of 2 weeks. More trials of inhaled steroids should be undertaken and these should include long-term follow-up.