Systemic corticosteroid use and neurodevelopmental outcomes in preterm infants: a cohort study

The risk-benefit balance and safety of postnatal corticosteroid use for chronic lung disease (PNCSCLD) in preterm infants is a controversial matter. Our objective was to determine the trends in the use of PNCSCLD over eleven years and to analyze the neurodevelopmental consequences of PNCSCLD in preterm infants at 18-42 months of corrected age.

The data for this retrospective population-based cohort study were obtained from ten tertiary neonatal intensive care units across New South Wales and the Australian Capital Territory, Australia. Preterm infants < 29⁺⁰ weeks' gestation born between January 1, 2007, and December 31, 2017, who were alive at discharge, without any major congenital anomalies were included and analyzed based on their PNCSCLD status.

Over eleven years, 611 (14.3%) out of 4258 infants received PNCSCLD. Among the 3386 eligible infants, 2636 (77.8%) underwent neurodevelopmental follow-up and were included in the final analysis. The rate of PNCSCLD use increased from 12.4% in 2007 to 19.6% in 2017. Similarly, the rate of moderate to severe functional disability (MSFD) increased from 8.8% in 2007 to 16.1% in 2017. Propensity-adjusted analysis revealed a greater odds ratio (OR) for MSFD in the PNCSCLD group than in the control group [average treatment effect: OR = 1.252, 95% confidence interval (CI) = 1.185-1.322, P ≤ 0.001; average treatment effect on the treated group: OR = 1.104, 95% CI = 1.031-1.184, P = 0.005].

PNCSCLD use was associated with a greater incidence of MSFD. Clinicians should exercise caution when using PNCSCLD.