Related Experiment Video
Updated: Jul 3, 2025
Intratracheal Instillation of Stem Cells in Term Neonatal Rats
Published on: May 4, 2020
Postnatal Steroids Use for Bronchopulmonary Dysplasia in a Quaternary Care NICU
Uthayakumaran Kanagaraj1, Jason Tan1, Amuchou Soraisham2
1Department of Pediatrics, Neonatal Division, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Postnatal steroids (PNS) were given to 8% of preterm infants, with stable use but increased dosage for bronchopulmonary dysplasia (BPD). This study highlights variations in PNS administration and suggests interventions to optimize care for premature infants.
Area of Science:
- Neonatalogy
- Pediatric Pulmonology
- Clinical Pharmacology
Background:
- Postnatal steroid (PNS) use in preterm infants for bronchopulmonary dysplasia (BPD) shows intercenter variation.
- Understanding intracenter patterns of PNS administration is crucial for developing targeted interventions to improve outcomes.
- This study focuses on analyzing PNS use within a single quaternary neonatal intensive care unit (NICU).
Purpose of the Study:
- To quantify the proportion and describe the patterns of PNS use in preterm infants.
- To analyze the timing, type, trends, and deviations in PNS regimens.
- To describe the clinical characteristics and outcomes of infants receiving PNS.
Main Methods:
- A cohort study was conducted in a quaternary NICU.
- Infants born before 33 weeks gestation receiving PNS for BPD between 2011 and 2021 were included.
- Data collected included PNS proportion, type, initiation age, duration, trends, regimen deviations, and clinical outcomes.
Main Results:
- 8% of infants (<33 weeks) received PNS, with stable overall use but a 56% increase in cumulative median dose for BPD.
- Dexamethasone was the most common initial PNS (85%), with 39% receiving multiple courses.
- Nearly one-third of the PNS dose was for non-BPD indications, and 46% of infants deviated from published regimens.
Conclusions:
- Increased variation in PNS use, regimen deviations, and use for non-BPD indications necessitate targeted interventions.
- The findings provide insights for optimizing PNS administration processes within NICUs.
- Center-specific interventions can help minimize clinical practice variations and improve care for preterm infants.
Objective:
Intercenter variation and trends in postnatal steroids (PNS) use among preterm infants for prevention or treatment of bronchopulmonary dysplasia (BPD) is known. Understanding intracenter PNS use patterns facilitate implementation of center-specific change interventions to optimize outcomes.This study aimed to (i) quantify the proportion of infants who received PNS, and describe the timing, type, trends over time, regimen used, and deviations, and (2) describe the clinical characteristics and unadjusted outcomes of infants who received PNS.
Study Design:
This was a cohort study in a quaternary neonatal intensive care unit including infants born at less than 33 weeks, and who received PNS for prevention or treatment of BPD between 2011 and 2021. Following data were included: proportion of babies who received PNS; type of PNS; age at initiation and duration; trends over time; deviation from published regimen; morbidity, mortality, and cointerventions.
Results:
One hundred and eighty four infants (8% of <33 week' infants) received PNS. The median (interquartile range [IQR]) gestational age and birth weight were 25 (24-26) weeks and 720 (625-841) grams, respectively. The median (IQR) day of initiation and duration of PNS use were 29 (19-38) and 10 (10-22) days, respectively. One hundred and fifty-seven (85%) infants received dexamethasone (DX) and 22 (12%) received hydrocortisone as the first PNS course, and 71 (39%) infants received multiple courses. The proportion of infants receiving PNS remained unchanged, but the cumulative median dose received for BPD per patient increased by 56%. Nearly one-third of cumulative PNS dose came from PNS used for non-BPD indications. Forty-six percent infants had a deviation from published regimen (±20% deviation in duration or ±10% deviation in dose). Survival, survival without major morbidity, moderate-to-severe BPD, and technology dependence at discharge were 87, 2, 91, and 67%, respectively.
Conclusion:
Increased variation in PNS use, deviation from published regimen, and concurrent PNS exposure from non-BPD indication offer insights into implementing interventions to improve processes.
Key Points:
· In this quaternary NICU, 8% of infants born before 33 weeks were administered postnatal steroids (PNS).. · The percentage of infants given PNS remained stable; however, the cumulative dose per patient for BPD rose.. · The study identified targeted interventions to minimize clinical practice variations at the center..
Related Concept Videos
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
01:17Drugs Used in Lower Respiratory Disorders: Overview
Bronchodilators, the first step of respiration enhancement, come in various forms, each with its own mechanism...
01:30Asthma-IV: Nursing Management
First, in...
01:23Upper Respiratory Drugs: Antitussives, Expectorants, and Mucolytics
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla. Benzonatate operates peripherally within the respiratory tract by...
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include: