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Time-related changes in steroid use and bronchopulmonary dysplasia in preterm infants
Bradley A Yoder1, Megan Harrison, Reese H Clark
1aDepartment of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah 84158-1289, USA. bradley.yoder@hsc.utah.edu
Insights
Decreased use of dexamethasone (DEX) in premature infants was linked to higher rates of bronchopulmonary dysplasia (BPD). Hydrocortisone (HC) use increased as DEX use declined, highlighting a shift in steroid management for neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Bronchopulmonary dysplasia (BPD) remains a significant concern in extremely preterm infants.
- Steroid use, including dexamethasone (DEX) and hydrocortisone (HC), has been explored for managing BPD.
- Trends in steroid use and their impact on BPD incidence require ongoing evaluation.
Purpose of the Study:
- To analyze temporal trends in the use of dexamethasone (DEX) and hydrocortisone (HC) in premature infants.
- To investigate the association between changing steroid use patterns and the incidence of bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age.
Main Methods:
- Analysis of a large cohort (N=77520) of neonates born between 23 to 32 weeks' gestation (1997-2006).
- Comparison of DEX and HC usage, and BPD rates (defined by oxygen use at 36 weeks' postmenstrual age) across different years and gestational ages.
- Statistical analysis using Mantel-Haenszel chi-squared tests to assess trends.
Main Results:
- Dexamethasone (DEX) use significantly decreased from 25.0% in 1998 to 6.8% in 2006, while hydrocortisone (HC) use increased.
- The median age for initiating DEX therapy increased by over two weeks during the study period.
- Overall BPD rates rose from 19% to 25% between 1997 and 2006, with a notable increase in severe BPD and a significant association between decreased DEX use and increased BPD rates in infants between 23 and 28 weeks' gestation.
Conclusions:
- Significant shifts in steroid preferences (away from DEX, towards HC) occurred in neonatal care over a decade.
- Reduced dexamethasone (DEX) administration correlated with increased incidence of bronchopulmonary dysplasia (BPD), including severe cases, in very preterm infants.
- Further high-quality randomized trials are necessary to guide optimal steroid therapy and long-term outcomes for high-risk infants.
Objective:
To assess dexamethasone (DEX) and hydrocortisone (HC) use in premature infants over time and the association of steroid use with the incidence of bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age.
Methods:
We analyzed data from the Pediatrix database for neonates of 23 to 32 weeks' gestation managed during 1997-2006 (N = 77520). We compared the use of DEX, HC and BPD (defined by oxygen use at 36 weeks' postmenstrual age) according to year and estimated gestational age. Mantel-Haenszel chi(2) was used to compare the trends in steroid use and BPD rates according to year.
Results:
There were no differences by year in the proportion of births at each gestation or in early or late neonatal death. DEX use decreased from a peak of 25.0% in 1998 to 6.8% in 2006, but HC use increased from 1.1% in 1997 to a peak of 6.5% in 2006. The median age at initiation of DEX use increased >2 weeks from 1997 to 2006. BPD rates increased from 19% in 1997 to 25% by 2006. Rates for severe BPD (defined by positive pressure support) also increased significantly over time. Between 23 and 28 weeks, there was a significant increase in BPD rates associated with the decrease in DEX over time.
Conclusions:
Steroid use and preference have changed significantly over the past decade. Decreased use of DEX was associated with increased rates of BPD, any or severe, among very preterm infants. Well-designed, randomized, noncrossover trials with long-term outcome analysis of high-risk infants are needed.
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