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Less postnatal steroids, more bronchopulmonary dysplasia: a population-based study in very low birthweight infants
E S Shinwell1, L Lerner-Geva, A Lusky
1Department of Neonatology, Kaplan Medical Center, Rehovot, Hadassah Medical School, Hebrew University, Jerusalem, Israel. eric_ s@clalit.org.il
Insights
Reduced postnatal steroid use in very low birthweight (VLBW) infants with bronchopulmonary dysplasia (BPD) was linked to increased oxygen dependency. This trend was observed despite a modest prolongation in oxygen therapy duration and an increase in survival rates.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Clinical Pharmacology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting premature infants.
- Postnatal steroids have been used to treat BPD, but concerns exist regarding adverse effects.
- There has been a trend towards reducing steroid use in very low birthweight (VLBW) infants.
Purpose of the Study:
- To investigate the association between decreased postnatal steroid administration for BPD in VLBW infants.
- To evaluate the impact of reduced steroid use on oxygen dependency at 28 days and 36 weeks postmenstrual age.
Main Methods:
- A large-scale national database study utilizing the Israel National VLBW Neonatal Database.
- Analysis of infants born between 1997 and 2004 (gestational age 24-32 weeks) requiring respiratory support.
- Comparison of four distinct time periods reflecting declining steroid use, employing multivariate regression to control for confounders.
Main Results:
- Steroid use significantly decreased from 23.5% to 11% between 1997-8 and 2003-4.
- Reduced steroid use was associated with increased odds of oxygen dependency at 28 days (OR 1.75) and 36 weeks postmenstrual age (OR 1.41).
- Mean oxygen therapy duration slightly increased, while infant survival rates improved significantly (78.5% to 81.6%).
Conclusions:
- A considerable reduction in postnatal steroid use for BPD in VLBW infants has occurred.
- This reduction is temporally linked to a higher incidence of oxygen dependency.
- The observed increase in oxygen therapy duration was modest, and survival rates improved.
Objective:
To study the association between reduced use of postnatal steroids for bronchopulmonary dysplasia (BPD) in very low birthweight (VLBW) infants and oxygen (O(2))-dependency at 28 days of age and at 36 weeks postmenstrual age.
Design:
Large national database study.
Setting:
The Israel National VLBW Neonatal Database.
Patients:
The sample included infants born between 1997 and 2004, of gestational age 24-32 weeks, who required mechanical ventilation or O(2) therapy. Four time periods were compared: 1997-8 (era 1, peak use), 1999-2000 (era 2, intermediate), 2001-2 (era 3, expected reduction) and 2003-4 (era 4, lowest). The outcome variable "oxygen dependency" was based on clinical criteria. Multivariate regression models were used to account for confounding variables.
Results:
Steroid use fell significantly from 23.5% in 1997-8 to 11% in 2003-4 (p<0.005). After adjustment for relevant confounding variables, the odds ratio for O(2) therapy at 28 days in era 4 versus era 1 was 1.75, 95% confidence interval (CI) 1.47 to 2.09 and 1.41, 95% CI 1.15 to 1.73 at 36 weeks postmenstrual age. The mean duration of O(2) therapy increased from 25.3 days (95% CI 23.3 to 26.3) in era 1, to 28.0 days (95% CI 26.6 to 29.4) in era 4. Survival increased from 78.5% in era 1 to 81.6% in era 4 (p<0.005).
Conclusions:
The use of steroids has fallen considerably since the awareness of the adverse effects of this treatment. This change has been temporally associated with increased O(2) dependency at 28 days of age and at 36 weeks postmenstrual age. The prolongation of O(2) therapy was modest in degree.
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