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Presumed adrenal insufficiency in neonates treated with corticosteroids for the prevention of bronchopulmonary dysplasia

Journal of Perinatology volume 42, pages 65–71 (2022)Cite this article

Subjects

Abstract

Objective

To determine if extremely preterm (EPT) neonates receiving dexamethasone for the prevention of BPD have a higher incidence of presumed adrenal insufficiency (PAI).

Study design

Retrospective cohort study of neonates <28 weeks gestation examining PAI after dexamethasone use and PAI after intratracheal budesonide with surfactant administration.

Result

Of 332 neonates, 38% received dexamethasone. The incidence of PAI was higher in neonates who had received dexamethasone (20.8% vs 2.9%, p < 0.001). However, for intubated babies receiving surfactant, dexamethasone was not independently associated with increased PAI after adjusting for gestational age, birthweight, and race (aOR 2.92, 95% CI: 0.79–10.85). Dexamethasone was independently associated with increased PAI in infants previously receiving budesonide/surfactant treatment (aOR 5.38, 95% CI: 1.38–20.90).

Conclusion

The use of dexamethasone alone was not associated with increased PAI, when adjusted for prematurity-related factors. The combination of budesonide with dexamethasone was significantly associated with increased PAI.

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Fig. 1: Flow diagram showing patient inclusion/exclusion criteria for the Total Cohort.

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Author information

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO, USA

    Justin B. Josephsen, Connie D. Anderson & Noah H. Hillman

  2. Cincinnati Children’s Hospital Medical Center, Department of Pharmacy, Cincinnati, OH, USA

    Brianna M. Hemmann

  3. The Christ Hospital Health Network, Department of Pharmacy, Cincinnati, OH, USA

    Brett M. Hemmann

  4. Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA

    Paula M. Buchanan

  5. SSM Health Cardinal Glennon Children’s Hospital, Department of Pharmacy, St. Louis, MO, USA

    Howard L. Williams & Lisa M. Lubsch

  6. Southern Illinois University Edwardsville School of Pharmacy, Department of Pharmacy Practice, Edwardsville, IL, USA

    Lisa M. Lubsch

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  1. Justin B. Josephsen
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Contributions

JJ conceptualized the study, wrote and reviewed the draft as submitted. NH conceptualized the study, provided interpretation of the results, and reviewed the draft as submitted. LL was engaged in the study design and interpretation of the results and reviewed the final draft as submitted. BH and BH wrote early drafts of the manuscript, conceptualized the study, and approved the final draft as submitted. HW extracted the data from the EMR and reviewed the final manuscript as submitted. CA ensured the integrity of the data extracted from the EMR, provided interpretation of the results, and reviewed the final document as submitted. PB analyzed and provided interpretation of the data and edited the final manuscript as submitted.

Corresponding author

Correspondence to Justin B. Josephsen.

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Competing interests

The authors declare no competing interests.

Ethics approval

This study (#28487) was approved by the Saint Louis University Institutional Review Board with a waiver of HIPAA authorization. The study was performed in accordance with the Declaration of Helsinki.

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Josephsen, J.B., Hemmann, B.M., Anderson, C.D. et al. Presumed adrenal insufficiency in neonates treated with corticosteroids for the prevention of bronchopulmonary dysplasia. J Perinatol 42, 65–71 (2022). https://doi.org/10.1038/s41372-021-01251-y

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