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Published on: May 4, 2020
Outcomes of postnatal systemic corticosteroids administration in ventilated preterm newborns: a systematic review of
Giovanni Boscarino1, Viviana Cardilli1, Maria Giulia Conti1
1Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Insights
Systemic corticosteroids improve respiratory outcomes and reduce extubation time in preterm infants but long-term neurodevelopmental effects remain unclear. Dexamethasone is more effective than hydrocortisone but carries risks.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Pharmacology
Background:
- Prolonged mechanical ventilation in preterm newborns increases bronchopulmonary dysplasia (BPD) risk.
- Systemic corticosteroids are increasingly used for BPD prevention and management.
- Long-term outcomes of these treatments require thorough evaluation.
Purpose of the Study:
- To systematically review randomized controlled trials (RCTs) on systemic corticosteroids in preterm infants.
- To evaluate associations with long-term neurodevelopment, growth, extubation rates, and adverse effects.
- To compare the efficacy and safety of different corticosteroids.
Main Methods:
- Systematic review of 39 RCTs published up to June 2023.
- Electronic searches in Medline, Scopus, and PubMed.
- Inclusion of studies on systemic corticosteroids, exclusion of inhaled forms.
Main Results:
- Systemic corticosteroids improve respiratory outcomes and reduce extubation time.
- Dexamethasone shows greater efficacy than hydrocortisone but with increased hypertension and hyperglycemia.
- Long-term growth and neurological outcomes remain largely unknown; adverse effects were similar across most studies.
Conclusions:
- Neonatal systemic corticosteroids, particularly dexamethasone, improve respiratory outcomes but require cautious use.
- Current evidence is inconclusive regarding long-term neurodevelopmental effects of systemic steroids in preterm infants.
Introduction:
Prolonged mechanical ventilation, commonly used to assist preterm newborns, increases the risk of developing bronchopulmonary dysplasia (BPD). In recent decades, studies have demonstrated that systemic corticosteroids play a significant role in the prevention and management of BPD. In this systematic review of randomized controlled trials (RCTs), we evaluated the association between the administration of systemic corticosteroids in preterm infants and its long-term outcomes, such as neurodevelopment, growth, extubation rate, and related adverse effects.
Methods:
We conducted an electronic search in Medline, Scopus, and PubMed using the following terms: "premature infants" and "corticosteroids." We considered all RCTs published up to June 2023 as eligible. We included all studies involving preterm newborns treated with systemic corticosteroids and excluded studies on inhaled corticosteroids.
Results:
A total of 39 RCTs were evaluated. The influence of steroids administered systemically during the neonatal period on long-term neurological outcomes remains unknown, with no influence observed for long-term growth. The postnatal administration of systemic corticosteroids has been found to reduce the timing of extubation and improve respiratory outcomes. Dexamethasone appears to be more effective than hydrocortisone, despite causing a higher rate of systemic hypertension and hyperglycemia. However, in the majority of RCTs analyzed, there were no differences in the adverse effects related to postnatal corticosteroid administration.
Conclusion:
Dexamethasone administered during the neonatal period appears to be more effective than hydrocortisone in terms of respiratory outcomes; however, caution should be taken when administering dexamethasone. Data derived from current evidence, including meta-analyses, are inconclusive on the long-term effects of the administration of systemic steroids in preterm infants or the possibility of neurodevelopmental consequences.
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