Postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia in preterm infants

Area of Science:

• Neonatology
• Pediatric Pulmonology
• Pharmacology

Background:

• Bronchopulmonary dysplasia (BPD) is a major cause of morbidity and mortality in preterm infants.
• Historically, postnatal corticosteroids like dexamethasone have been used to prevent and treat BPD.
• Concerns exist regarding neurodevelopmental risks and mortality associated with early corticosteroid use.

Purpose of the Study:

• To evaluate the efficacy and safety of prophylactic hydrocortisone for preventing BPD in preterm infants.
• To assess the neurodevelopmental outcomes at 2 years of age.
• To provide updated recommendations on the use of corticosteroids for BPD prevention and treatment.

Main Methods:

• A review of current evidence on postnatal corticosteroid use for BPD.
• Analysis of studies investigating prophylactic hydrocortisone initiated within 48 hours post-birth.
• Examination of data on dexamethasone use after the first week post-birth and inhaled corticosteroids.

Main Results:

• Prophylactic physiological-dose hydrocortisone, initiated early and without indomethacin, improves survival without BPD and shows no adverse neurodevelopmental effects at 2 years.
• Routine early dexamethasone for BPD prevention is not recommended due to increased risks of cerebral palsy.
• Low-dose dexamethasone may be considered after the first week for high-risk infants with evolving BPD; hydrocortisone is not proven for treating established BPD.

Conclusions:

• Early prophylactic hydrocortisone is a potential therapeutic option for preterm infants at high risk for BPD.
• Dexamethasone use should be restricted, with specific considerations for late-stage intervention in select cases.
• Inhaled corticosteroids are not supported for BPD treatment based on current evidence.