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Respiratory severity score-guided postnatal systemic corticosteroid therapy for bronchopulmonary dysplasia in

Gyeong Eun Yeom1, Ju Sun Heo1,2, Baek Sup Shin1

  • 1Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.

Clinical and Experimental Pediatrics
|August 8, 2025
PubMed

Insights

A new respiratory severity score (RSS)-guided protocol for extremely preterm (EP) infants reduced severe bronchopulmonary dysplasia (BPD) without impacting neurodevelopmental outcomes. This targeted approach refines steroid therapy for vulnerable newborns.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Clinical Trial Methodology

Background:

  • Bronchopulmonary dysplasia (BPD) is a significant complication in extremely preterm (EP) infants.
  • Postnatal systemic corticosteroids are used to manage BPD but raise concerns about neurodevelopmental outcomes.
  • Optimal timing and criteria for initiating steroid therapy for BPD remain unclear.

Purpose of the Study:

  • To evaluate a respiratory severity score (RSS)-guided postnatal systemic corticosteroid protocol.
  • To assess the impact of this protocol on BPD severity and neurodevelopmental outcomes in mechanically ventilated EP infants.

Main Methods:

  • A historical comparative study comparing pre- and post-protocol implementation (2010-2014 vs. 2016-2022).
  • Inclusion criteria: infants born <28 weeks' gestation, ventilated on postnatal day 14.
  • The protocol used RSS to guide corticosteroid initiation; BPD severity and neurodevelopmental impairment (NDI) were compared.

Main Results:

  • The post-protocol group showed increased dexamethasone use and earlier initiation.
  • Significant increase in Jensen grade 0 BPD in the post-protocol group, especially in non-steroid treated infants.
  • Steroid-treated infants in the post-protocol group had decreased severe BPD (grade 3) and increased mild BPD (grade 1).
  • No significant differences in mortality or severe neurodevelopmental impairment between groups.

Conclusions:

  • The RSS-guided protocol facilitates targeted and earlier steroid administration.
  • This strategy effectively reduces severe BPD without adverse neurodevelopmental effects.
  • The RSS-guided approach offers a refined strategy for postnatal corticosteroid treatment in EP infants.
Abstract

Keywords:
Bronchopulmonary dysplasiaDexamethasoneExtremely prematureInfant

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