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Impact of postnatal dexamethasone timing on preterm mortality and bronchopulmonary dysplasia: a propensity score

T'ng Chang Kwok1, Lisa Szatkowski1, Don Sharkey2

  • 1Centre for Perinatal Research, Population and Lifespan Science, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK.

The European Respiratory Journal
|August 17, 2023
PubMed

Insights

Starting postnatal dexamethasone (PND) later in preterm infants, after 5 weeks, is linked to worse respiratory outcomes and death. Early PND (2-3 weeks) may be safer for high-risk infants. Further trials are needed.

Area of Science:

  • Neonatalogy
  • Pediatric Pulmonology
  • Pharmacology

Background:

  • Postnatal dexamethasone (PND) is administered to high-risk preterm infants to aid extubation and prevent bronchopulmonary dysplasia (BPD).
  • The optimal timing for initiating PND remains uncertain, impacting clinical decisions.
  • This study investigates the association between PND timing and infant outcomes.

Purpose of the Study:

  • To explore the relationship between the timing of postnatal dexamethasone (PND) initiation and mortality and respiratory outcomes in preterm infants.
  • To identify if specific PND treatment windows are associated with improved or worsened outcomes.

Main Methods:

  • Retrospective analysis of 84,440 preterm infants (<32 weeks GA) from the National Neonatal Research Database (2010-2020).
  • Propensity score weighting was used to analyze PND initiated at 2-3 weeks (PND2/3), 4-5 weeks (PND4/5), and after 5 weeks (PND6+).
  • Primary outcome: composite of death before discharge and/or severe BPD; secondary outcomes included extubation timing and respiratory support at discharge.

Main Results:

  • Infants receiving PND6+ had higher odds of death/severe BPD (OR 1.68) and later extubation (3.1 weeks) compared to PND2/3.
  • PND6+ was associated with lower in-hospital mortality (OR 0.38) but increased need for respiratory support at discharge (OR 1.34).
  • PND4/5 showed no significant association with severe BPD or discharge respiratory support.

Conclusions:

  • Initiating PND after 5 weeks of age is linked to adverse respiratory outcomes, though residual bias is possible.
  • The findings suggest a potential benefit of earlier PND initiation (2-3 weeks) for certain outcomes.
  • A clinical trial is recommended to establish the optimal PND treatment window using early risk stratification.
Abstract

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