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Extended course of prednisolone in infants with severe bronchopulmonary dysplasia
Alaina Linafelter1, Alain Cuna2, Cynthia Liu3
1Department of Pharmacy, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA.
Insights
Long-term prednisolone in preterm infants with severe bronchopulmonary dysplasia (BPD) shows a small, short-term respiratory benefit but impairs linear growth. The findings suggest long-term use is not favored due to the risk-benefit profile.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Pharmacology
Background:
- Limited data exist on the efficacy and safety of prednisolone for preterm infants diagnosed with bronchopulmonary dysplasia (BPD).
- This study addresses the need for more information on chronic prednisolone therapy in severe BPD cases.
Purpose of the Study:
- To evaluate the use of chronic prednisolone in infants with severe BPD.
- To assess the impact of prednisolone on respiratory status.
- To document the effects of prednisolone on infant growth.
Main Methods:
- A retrospective cohort study was conducted at a single center.
- Included were preterm infants receiving at least 30 days of prednisolone for severe BPD.
- Outcomes measured weekly included Pulmonary Severity Score (PSS) and changes in weight, length, and head circumference.
Main Results:
- Forty-three infants (mean birth weight 729g, gestational age 26 weeks) were analyzed.
- Prednisolone therapy led to a modest, short-term decrease in PSS after one week (p=0.03).
- Linear growth (length z-scores) was negatively impacted after four weeks of treatment (p=0.04), with no significant changes in weight or head circumference.
Conclusions:
- Long-term prednisolone therapy in severe BPD offers a modest short-term improvement in respiratory status but is associated with impaired linear growth.
- The risk-benefit profile suggests that long-term prednisolone use is not advisable for infants with severe BPD.
Background:
There are few published data on the efficacy and safety of prednisolone in preterm infants with bronchopulmonary dysplasia (BPD).
Aims:
To describe the use of chronic prednisolone therapy in a population of infants with severe BPD, examine potential benefits on respiratory status, and document potential effects on growth.
Study Design:
Single-center retrospective cohort study.
Subjects:
Preterm infants who had received ≥30 days of prednisolone for the treatment of severe BPD.
Outcome Measures:
Weekly changes in Pulmonary Severity Score (PSS), as well as weekly changes in weight, length, and head circumference during prednisolone therapy.
Results:
Forty-three infants (mean birth weight 729 g; mean gestational age 26 weeks) were identified. The average age at start of prednisolone treatment was 42.5 ± 5.9 weeks; while the median duration and median cumulative dose of prednisolone therapy were 67 (IQR 57-107) days and 61.3 (IQR 39.9-93.3) mg/kg, respectively. PSS decreased after 1 week of prednisolone therapy (mean difference, 0.19; 95% Cl, 0.01 to 0.37; p = 0.03). No further reduction in PSS was noted despite continued treatment. Length z-scores decreased after 4 weeks of continued treatment (mean difference 0.6; 95% CI 0.01 to 1.1; P = 0.04), while weight and head circumference did not change.
Conclusions:
In one of the first reports on prednisolone therapy for severe BPD, we describe that long-term prednisolone is associated with modest short-term improvement in PSS, but impairs linear growth. Our results suggest a risk-benefit profile of prednisolone that does not favor long-term use in infants with severe BPD.
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