Postnatal steroid management in preterm infants with evolving bronchopulmonary dysplasia

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Pharmacology

Background:

• Bronchopulmonary dysplasia (BPD) is a chronic lung disease in extremely preterm infants.
• While mechanical ventilation and oxygen are known factors, perinatal events may also trigger inflammation leading to BPD.
• Corticosteroids like dexamethasone and hydrocortisone have anti-inflammatory properties beneficial for BPD.

Purpose of the Study:

• To review corticosteroid pharmacology relevant to BPD.
• To evaluate evidence for postnatal corticosteroid use in preterm infants.
• To assess management strategies for BPD and adrenal suppression from steroid use.

Main Methods:

• Literature review of pharmacological properties of corticosteroids.
• Appraisal of clinical trial data on postnatal corticosteroid use in preterm infants.
• Synthesis of clinical experience for managing steroid-induced adrenal suppression.

Main Results:

• Postnatal corticosteroids demonstrate efficacy in preventing and managing BPD in preterm infants.
• Evidence supports the anti-inflammatory role of corticosteroids in BPD management.
• Strategies for managing prolonged steroid exposure and adrenal suppression are discussed.

Conclusions:

• Corticosteroids are valuable in managing BPD in preterm infants.
• Careful consideration of steroid management strategies is crucial.
• Further guidance is provided for managing adrenal suppression, an understudied area.