Postnatal Corticosteroids Policy for Very Preterm Infants and Bronchopulmonary Dysplasia

Area of Science:

• Neonatology
• Pediatric Pulmonology
• Clinical Epidemiology

Background:

• Postnatal corticosteroids (PNC) effectively reduce bronchopulmonary dysplasia (BPD) in very preterm neonates.
• However, PNC use is linked to adverse effects like cerebral palsy, and its application varies significantly across European neonatal intensive care units (NICUs).

Purpose of the Study:

• To investigate the association between varying levels of PNC use and the risk of mortality or BPD in European NICUs.
• To determine if NICUs with low PNC use or explicit policies to reduce PNC have different outcomes compared to those with higher use.

Main Methods:

• Analysis of the EPICE cohort, including 3,126 infants born between 24-29 weeks' gestational age across 105 NICUs in 11 countries.
• Hierarchical clustering identified NICU groups based on PNC use and BPD prevalence.
• Multilevel analysis assessed the relationship between restrictive PNC policies and BPD occurrence.

Main Results:

• Three NICU clusters emerged: low PNC/low BPD, low PNC/high BPD, and high PNC/medium BPD.
• No significant difference in neonatal mortality was observed between clusters (p = 0.88).
• A restrictive PNC policy was not associated with an increased risk of BPD (OR 0.68; 95% CI: 0.45-1.03).

Conclusions:

• Nearly half of European NICUs achieved low PNC use with low BPD rates, without increased mortality.
• Infants in NICUs with a policy to restrict PNC did not face a higher risk of developing BPD.