Postnatal Corticosteroids to Prevent or Treat Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD) remains a major morbidity for infants born preterm. Postnatal corticosteroids might reduce the risk of developing BPD, or reduce its severity when it occurs, because of their powerful anti-inflammatory effects. However, corticosteroids have adverse effects, including on the developing brain. There have been numerous randomized clinical trials of corticosteroids given via various routes, of varying types, and started at different postnatal ages. There is some evidence that inhaled corticosteroids started earlier in the postnatal period may reduce BPD, but increase mortality. Inhaled corticosteroids started after the first week of age have little effect, but data are sparse. Systemic corticosteroids started in the first week after birth reduce BPD but increase cerebral palsy. Systemic corticosteroids started after the first week of age reduce both BPD and mortality, without evidence of long-term neurological harm. However, no studies have been powered to look for important adverse long-term neurological effects. Of the 2 systemic corticosteroids assessed, most effects relate to dexamethasone and not to hydrocortisone, but hydrocortisone in the first week after birth may reduce mortality, and is worthy of further study. There are limited data directly comparing inhaled versus systemic corticosteroids, with no evidence of superiority of one mode over the other. Corticosteroids instilled into the trachea using surfactant as a vehicle to distribute the drug through the lungs offer promise in preventing BPD. For current clinical practice, systemic corticosteroids should be avoided in the first week of life, and thereafter used only in infants at high risk of BPD.