Timing of postnatal steroids for bronchopulmonary dysplasia: association with pulmonary and neurodevelopmental

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Updated: Dec 29, 2025

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
19:15

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

Published on: August 25, 2014

87.3K

Heidi M Harmon1, Erik A Jensen2, Sylvia Tan3

  • 1Department of Pediatrics, University of Iowa, Iowa City, IA, USA. heidi-harmon@uiowa.edu.

Journal of Perinatology : Official Journal of the California Perinatal Association
|February 6, 2020
PubMed

Insights

Early postnatal corticosteroids (PNS) exposure before 50 days of life may reduce the risk of severe bronchopulmonary dysplasia (BPD) in preterm infants. Neurodevelopmental impairment risk was not significantly affected by PNS timing.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Developmental Pediatrics

Background:

  • Bronchopulmonary dysplasia (BPD) and neurodevelopmental impairment (NDI) are significant morbidities in preterm infants.
  • Postnatal corticosteroids (PNS) are used to manage respiratory distress but their optimal timing is debated.
  • Understanding the association between PNS timing and outcomes is crucial for clinical practice.

Purpose of the Study:

  • To investigate the relationship between the age of first postnatal corticosteroid (PNS) exposure and the risk of severe bronchopulmonary dysplasia (BPD).
  • To assess the association between the timing of initial PNS exposure and the risk of neurodevelopmental impairment (NDI) in extremely preterm infants.

Main Methods:

  • A cohort study included 951 infants born before 27 weeks of gestational age.
  • Infants received PNS between 8 days of life (DOL) and 36 weeks' postmenstrual age.
  • Adjusted odds ratios (aOR) were calculated to compare outcomes based on PNS exposure timing.

Main Results:

  • Compared to exposure between 22-28 DOL, severe BPD risk was higher for PNS initiated at DOL 50-63 (aOR 1.77) and DOL ≥64 (aOR 3.06).
  • PNS exposure between DOL 8 and 49 showed similar severe BPD risk compared to the reference group.
  • No significant variation in NDI risk was observed based on the age of PNS exposure.

Conclusions:

  • Initiating PNS before 50 DOL is associated with lower odds of severe BPD in high-risk preterm infants.
  • The timing of initial PNS exposure may be a modifiable factor to reduce BPD severity.
  • Further research could explore optimal PNS protocols to balance benefits and risks.
Abstract

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