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Updated: Aug 11, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Prospective evaluation of postnatal steroid administration: a 1-year experience from the California Perinatal Quality
Neil N Finer1, Richard J Powers, Chia-hao Simon Ou
1Department of Neonatology, University of California San Diego Medical Center, San Diego, CA 92103-8774, USA. nfiner@ucsd.edu
Insights
Postnatal steroids (PNSs) are increasingly used for non-chronic lung disease (CLD) indications like hypotension in very low birth weight (VLBW) infants. This early use is linked to higher rates of intraventricular hemorrhage, periventricular leukomalacia, and death, necessitating urgent trials.
Area of Science:
- Neonatal Medicine
- Pediatric Pharmacology
- Clinical Trials
Background:
- Postnatal steroids (PNSs) are commonly used for chronic lung disease (CLD) in very low birth weight (VLBW) infants.
- Concerns exist regarding neurodevelopmental abnormalities associated with PNS use in VLBW infants.
- Corticosteroids are being explored as an alternative therapy for hypotension in VLBW infants.
Purpose of the Study:
- To investigate the current use of PNSs in VLBW infants for various indications.
- To assess the association between PNS use for non-CLD indications, specifically hypotension, and infant outcomes.
- To highlight the need for prospective trials on the risk-benefit of early corticosteroid use in VLBW infants.
Main Methods:
- Data collected from 1401 VLBW infants across 22 hospitals in California (April 2002-March 2003).
- Supplemental data on PNS use, indication, agent, dose, and treatment details were recorded.
- Infant outcomes including intraventricular hemorrhage, periventricular leukomalacia, and death were compared based on PNS indication.
Main Results:
- 19.3% of VLBW infants received PNSs; 11.8% for non-CLD indications and 4.0% for both CLD and non-CLD.
- Hypotension was the most common non-CLD indication for PNS use (16.3% of treated infants).
- Infants treated with PNSs for hypotension showed significantly higher rates of intraventricular hemorrhage, periventricular leukomalacia, and death compared to those treated for CLD or not receiving PNSs.
Conclusions:
- Early use of hydrocortisone for hypotension in VLBW infants is common but associated with high morbidity and mortality.
- The findings were previously unrecognized and underscore the urgent need for prospective trials.
- Evaluating the short- and long-term risk-benefit of such treatments is crucial for VLBW infant care.
Objective:
Postnatal steroids (PNSs) are used frequently to prevent or treat chronic lung disease (CLD) in the very low birth weight (VLBW) infant, and their use continues despite concerns regarding an increased incidence of longer-term neurodevelopmental abnormalities in such infants. More recently, there has been a suggestion that corticosteroids may be a useful alternative therapy for hypotension in VLBW infants, but there have been no prospective reports of such use for a current cohort of VLBW infants.
Methods:
The California Perinatal Quality Care Collaborative (CPQCC) requested members to supplement their routine Vermont Oxford Network data collection with additional information on any VLBW infant treated during their hospital course with PNS, for any indication. The indication, actual agent used, total initial daily dose, age at treatment, type of respiratory support, mean airway pressure, fraction of inspired oxygen, and duration of first dosing were recorded.
Results:
From April 2002 to March 2003 in California, 22 of the 62 CPQCC hospitals reported supplemental data, if applicable, from a cohort of 1401 VLBW infants (expanded data group [EDG]), representing 33.2% of the VLBW infants registered with the CPQCC during the 12-month period. PNSs for CLD were administered to 8.2% of all VLBW infants in 2003, 8.6% of infants in the 42 hospitals that did not submit supplemental data (routine data-set group, compared with 7.6% in EDG hospitals). Of the 1401 VLBW infants in the EDG, 19.3% received PNSs; 3.6% received PNSs for only CLD, 11.8% for only non-CLD indications, and 4.0% for both indications. At all birth weight categories, non-CLD use was significantly greater than CLD use. The most common non-CLD indication was hypotension, followed by extubation stridor, for which 36 (16.3%) infants were treated. For hypotension, medications used were hydrocortisone followed by dexamethasone. Infants treated with PNSs exclusively for hypotension had a significantly higher incidence of intraventricular hemorrhage, periventricular leukomalacia, and death when compared with infants treated only for CLD or those who did not receive PNSs.
Conclusions:
The common early use of hydrocortisone for hypotension and the high morbidity and mortality in children receiving such treatment has not been recognized previously and prospective trials evaluating the short- and long-term risk/benefit of such treatment are urgently required.
