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Pattern of postnatal steroid use for bronchopulmonary dysplasia in extremely preterm infants

Journal of Perinatology volume 42, pages 1258–1259 (2022)Cite this article

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The use of postnatal steroids in preterm infants at risk of bronchopulmonary dysplasia (BPD) or with BPD is frequent, despite concerns about their adverse effects and despite strong statements from the AAP discouraging their use. Vermont Oxford Network data shows increasing trend in PNS use from 8.6% in 2009 to 13% in 2020 among infants 22–29 week gestation. However, there are no published reports of practice patterns of PNS use from recent years. Specifically there are no reports about the clinical scenarios in which PNS are used, the strategy (prophylactic vs. therapeutic), the exact medications, and treatment regimens of PNS being chosen in modern practice. Therefore we conducted a web-based survey of neonatologists (members of the Section of Neonatal-Perinatal medicine in the US) in June 2020 to determine clinicians’ preference and current practice of PNS use to prevent or treat BPD in extremely preterm infants.

The survey consisted of a vignette of an infant born at 25 weeks gestation requiring prolonged mechanical ventilation, with 13 questions regarding PNS use in such infants based on the age of initiation and type of steroid used. We defined PNS use based on the time of initiation [prophylactic: 1st week, treatment of evolving BPD (early: 7–14 days, moderately early: 15–21 days, moderately delayed: 22–28 days, delayed: >28 days) and treatment of established BPD at 36 weeks] and the type of steroid used [dexamethasone, hydrocortisone, prednisolone, and inhaled budesonide]. To analyze Likert scale responses, we combined the two highest and lowest responses into one category.

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Fig. 1: PNS use in ventilator dependent preterm infants: Proportion of respondents (y-axis) reporting use of PNS in a ventilator dependent preterm with evolving BPD by time of initiating PNS therapy (x-axis).

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Authors and Affiliations

  1. Children’s Hospital at Dartmouth, Lebanon, NH, USA

    Neetu Singh

  2. Nemours Children’s Hospital, Orlando, FL, USA

    Kanekal S. Gautham

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  1. Neetu Singh
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  2. Kanekal S. Gautham
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Contributions

NS conceptualized and designed the study, collected data, carried out the statistical analysis, drafted the initial manuscript, and reviewed and revised the manuscript. KSG conceptualized the study, and critically reviewed and revised the manuscript content. Both author approve the final manuscript as submitted, and agree to be accountable for all aspects of the work.

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Correspondence to Neetu Singh.

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The authors declare no competing interests.

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Singh, N., Gautham, K.S. Pattern of postnatal steroid use for bronchopulmonary dysplasia in extremely preterm infants. J Perinatol 42, 1258–1259 (2022). https://doi.org/10.1038/s41372-022-01353-1

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  • DOI: https://doi.org/10.1038/s41372-022-01353-1

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