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Factors associated with the response to postnatal dexamethasone use in very low birthweight infants: a nationwide
Seung Hwan Baek1, Jeong Eun Shin1, Jungho Han1
1Pediatrics, Severance Hospital, Seodaemun-gu, Seoul, Korea (the Republic of).
Insights
Dexamethasone is used in about 20.5% of preterm infants to prevent bronchopulmonary dysplasia (BPD), with use increasing in earlier gestations. Factors like inflammation and low birth weight are linked to poor response to dexamethasone therapy.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Dexamethasone is a common corticosteroid for preventing bronchopulmonary dysplasia (BPD) in preterm infants.
- Understanding dexamethasone use patterns and response factors is crucial for optimizing BPD management.
Purpose of the Study:
- To evaluate the epidemiology of dexamethasone use for BPD prevention in very low birthweight infants.
- To identify factors associated with dexamethasone response in this population.
Main Methods:
- Analysis of a nationwide database (Korean Neonatal Network) from 2013-2020.
- Inclusion of very low birthweight infants (gestational age 23-31 weeks).
- Comparison of respiratory outcomes between infants receiving dexamethasone ('Dex') and those not ('No Dex'), with univariate and multivariate analyses for response factors.
Main Results:
- 20.5% of 11,261 infants received dexamethasone; 74.1% of those had moderate-to-severe BPD.
- Dexamethasone use prevalence ranged from 17.7-22.3% annually.
- The 'Dex' group showed higher rates of moderate-to-severe BPD, invasive ventilation at 36 weeks postmenstrual age, and longer ventilator duration.
Conclusions:
- Dexamethasone was administered to 20.5% of preterm infants, with increased use in earlier gestations.
- Factors such as antenatal/postnatal inflammation, low birth weight, and early pulmonary hypertension were associated with poor dexamethasone response.
Background:
Dexamethasone is widely used as a systemic corticosteroid to treat and prevent bronchopulmonary dysplasia (BPD) in preterm infants. We evaluated the current epidemiology of dexamethasone use to prevent BPD and analyse the factors associated with the response to dexamethasone in very low birthweight infants using a nationwide database.
Methods:
We included very low birthweight infants born between January 2013 and December 2020 with a gestational age of 23-31 weeks using data from the Korean Neonatal Network registry. Patients were grouped based on their dexamethasone use into 'Dex' or 'No Dex' groups. Clinical variables and data were collected, and the annual trends of dexamethasone use and the proportion of patients who received dexamethasone according to gestational age were analysed. Respiratory outcomes were compared between the groups. Univariate and multivariate analyses were performed to analyse factors associated with the response to dexamethasone in BPD.
Results:
Of 11 261 eligible infants, 2313 (20.5%) received dexamethasone, and 1714 (74.1%) of them were diagnosed with moderate-to-severe BPD. The 8-year annual prevalence of dexamethasone use was 17.7-22.3%. The 'Dex' group had more moderate-to-severe BPD, more frequent invasive ventilation use at a postmenstrual age of 36 weeks and longer ventilator duration. Birth weight, 5-minute APGAR score, pulmonary hypertension within the first 28 days, surgical treatment of patent ductus arteriosus, medical treatment of patent ductus arteriosus, pathological chorioamnionitis, hydrocortisone or budesonide use, surgical management of necrotising enterocolitis and fungal sepsis were associated with BPD after dexamethasone use.
Conclusions:
Approximately 20.5% of preterm infants received dexamethasone, and the frequency increased as gestational age decreased. Poor response to dexamethasone was associated with antenatal and postnatal inflammation, low birth weight and early pulmonary hypertension.
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