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Systemic Steroids in Preventing Bronchopulmonary Dysplasia (BPD): Neurodevelopmental Outcome According to the Risk of
Noura Zayat1,2, Patrick Truffert2,3, Elodie Drumez2,4
1Department of Neonatology, University Hospital of Nantes, F-44093 Nantes, France.
Insights
Postnatal steroids (PNS) may increase gross motor impairment risk in preterm infants, irrespective of bronchopulmonary dysplasia (BPD) risk. Further trials should assess neurodevelopmental outcomes based on BPD risk.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Pharmacology
Background:
- Postnatal steroids (PNS) are used to prevent bronchopulmonary dysplasia (BPD) in preterm infants.
- PNS may have adverse neurodevelopmental effects, potentially influenced by BPD risk.
- This study investigated neurodevelopmental outcomes in preterm infants treated with PNS, stratified by BPD risk.
Purpose of the Study:
- To compare neurodevelopmental outcomes in preterm infants receiving PNS, categorized by their predicted risk of BPD.
- To evaluate the association between PNS and neurodevelopmental impairments, considering BPD risk stratification.
Main Methods:
- Developed a prediction model to classify infants (24-29 weeks gestation) into BPD risk groups.
- Utilized propensity score methods, including Inverse Probability of Treatment Weighting (IPTW), for comparative analysis.
- Assessed neurological outcomes at two years of corrected age.
Main Results:
- The BPD prediction model achieved an AUC of 0.82.
- PNS use was linked to an increased risk of gross motor impairment (OR 1.95) in the highest BPD risk group, irrespective of steroid type.
- Dexa/betamethasone, but not hydrocortisone, was associated with increased cognitive anomalies.
Conclusions:
- PNS may elevate the risk of gross motor impairment in preterm infants, independent of their BPD risk category.
- Future randomized controlled trials on PNS for BPD prevention should incorporate risk-based neurodevelopmental assessments.
- The findings require confirmation through further randomized controlled trials.
Background:
Postnatal steroids (PNS) have been used to prevent bronchopulmonary dysplasia (BPD) in preterm infants but have potential adverse effects on neurodevelopment. These effects might be modulated by their risk of BPD. We aimed to compare patients' neurodevelopment with PNS treatment according to their risk of BPD in a European cohort.
Methods:
We developed a prediction model for BPD to classify infants born between 24 + 0 and 29 + 6 weeks of gestation in three groups and compared patients' neurological outcome at two years of corrected age using the propensity score (PS) method.
Results:
Of 3662 neonates included in the analysis, 901 (24.6%) were diagnosed with BPD. Our prediction model for BPD had an area under the ROC curve of 0.82. In the group with the highest risk of developing BPD, PNS were associated with an increased risk of gross motor impairment: OR of 1.95 after IPTW adjustment (95% CI 1.18 to 3.24, p = 0.010). This difference existed regardless of the type of steroid used. However, there was an increased risk of cognitive anomalies for patients treated with dexa/betamethasone that was no longer observed with hydrocortisone.
Conclusions:
This study suggests that PNS might be associated with an increased risk of gross motor impairment regardless of the group risk for BPD. Further randomised controlled trials exploring the use of PNS to prevent BPD should include a risk-based evaluation of neurodevelopmental outcomes. This observation still needs to be confirmed in a randomised controlled trial.
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