Evolving neonatal steroid prescription habits and patient outcomes

Area of Science:

• Neonatal Medicine
• Pediatric Pharmacology
• Clinical Outcomes Research

Background:

• Indications for postnatal steroid administration in preterm infants are evolving.
• Previous studies suggest potential benefits and risks of postnatal steroids.

Purpose of the Study:

• To compare steroid use patterns between two cohorts of preterm infants separated by five years.
• To evaluate the short- and long-term outcomes associated with recent steroid use in preterm infants.

Main Methods:

• Retrospective chart review of infants born before 28 weeks gestational age.
• Comparison of two cohorts: January 2002-August 2003 and July 2008-March 2010.
• Analysis of steroid use, timing of death, and neurodevelopmental outcomes.

Main Results:

• Increased steroid use in the later cohort (20% vs 35%), with a significant shift towards hydrocortisone (7% vs 76%) and pulmonary indications (36% vs 61%).
• No improvement in survival rates was observed.
• Patients in the later cohort died later (8 days vs 30 days), with a correlation between steroid dose and time of death.
• Neurodevelopmental outcomes were worse in infants receiving steroids for pulmonary indications (26% severe adverse outcome vs 4.8%).

Conclusions:

• While postnatal steroids improved short-term respiratory status in preterm infants, this benefit was offset by increased age at death and no improvement in survival.
• The shift towards hydrocortisone for pulmonary indications was associated with poorer neurodevelopmental outcomes.
• Current steroid use practices in preterm infants require re-evaluation due to concerning long-term effects.