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Timing of postnatal steroids for bronchopulmonary dysplasia: association with pulmonary and neurodevelopmental outcomes



To determine the associations between age at first postnatal corticosteroids (PNS) exposure and risk for severe bronchopulmonary dysplasia (BPD) and neurodevelopmental impairment (NDI).

Study design

Cohort study of 951 infants born <27 weeks gestational age at NICHD Neonatal Research Network sites who received PNS between 8 days of life (DOL) and 36 weeks’ postmenstrual age was used to produce adjusted odds ratios (aOR).


Compared with infants in the reference group (22–28 DOL-lowest rate), aOR for severe BPD was similar for children given PNS between DOL 8 and 49 but higher among infants treated at DOL 50–63 (aOR 1.77, 95% CI 1.03–3.06), and at DOL ≥64 (aOR 3.06, 95% CI 1.44–6.48). The aOR for NDI did not vary significantly by age of PNS exposure.


For infants at high risk of BPD, initial PNS should be considered prior to 50 DOL for the lowest associated odds of severe BPD.

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Fig. 1
Fig. 2: Restricted cubic spline models showing adjusted probabilities of ratios for primary outcomes (BPD, NDI) and primary outcome combined with death by categories based on age of first initiation of steroids.
Fig. 3: Unadjusted rates and adjusted odds ratios for primary outcomes (BPD, NDI) and primary outcome combined with death by categories based on age of first initiation of steroids.

Data availability

Data reported in this paper may be requested through a data use agreement. Further details are available at


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The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Center for Research Resources, and the National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network’s Generic Database and Follow-up Studies through cooperative agreements. While NICHD staff did have input into the study design, conduct, analysis, and manuscript drafting, the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Data collected at participating sites of the NICHD Neonatal Research Network (NRN) were transmitted to RTI International, the data coordinating center (DCC) for the network, which stored, managed and analyzed the data for this study. On behalf of the NRN, AD (DCC Principal Investigator) and Douglas Kendrick (DCC Statistician) had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study.

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

Michael S. Caplan8, Abbott R. Laptook9, Martin Keszler9, Betty R. Vohr9, Barbara Alksninis9, Kristin M. Basso9, Robert Burke9, Melinda Caskey9, Katharine Johnson9, Mary Lenore Keszler9, Andrea M. Knoll9, Theresa M. Leach9, Emilee Little9, Elisabeth C. McGowan9, Elisa Vieira9, Victoria E. Watson9, Suzy Ventura9, Michele C. Walsh10, Anna Maria Hibbs10, Deanne E. Wilson-Costello10, Nancy S. Newman10, Allison H. Payne10, Bonnie S. Siner10, Monika Bhola10, Gulgun Yalcinkaya10, William E. Truog11, Eugenia K. Pallotto11, Howard W. Kilbride11, Cheri Gauldin11, Anne Holmes11, Kathy Johnson11, Allison Scott11, Kurt Schibler12, Edward F. Donovan12, Cathy Grisby12, Kate Bridges12, Barbara Alexander12, Estelle E. Fischer12, Holly L. Mincey12, Jody Hessling12, Teresa L. Gratton12, Lenora Jackson12, Kristin Kirker12, Greg Muthig12, Jean J. Steichen12, Stacey Tepe12, Kimberly Yolton12, Ronald N. Goldberg13, C. Michael Cotten13, Ricki F. Goldstein13, Patricia L. Ashley13, William F. 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Correspondence to Heidi M. Harmon.

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Members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network are listed below Acknowledgements.

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Harmon, H.M., Jensen, E.A., Tan, S. et al. Timing of postnatal steroids for bronchopulmonary dysplasia: association with pulmonary and neurodevelopmental outcomes. J Perinatol 40, 616–627 (2020).

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