Abstract
Despite significant progress in the treatment of preterm neonates, bronchopulmonary dysplasia (BPD) continues to be a major cause of neonatal morbidity. Affected infants suffered from long-term pulmonary and nonpulmonary sequel. The pulmonary sequels include reactive airway disease and asthma during childhood and adolescence. Nonpulmonary sequels include poor coordination and muscle tone, difficulty in walking, vision and hearing problems, delayed cognitive development, and poor academic achievement. As inflammation seems to be a primary mediator of injury in pathogenesis of BPD, role of steroids as antiinflammatory agent has been extensively studied and proven to be efficacious in management. However, evidence is insufficient to make a recommendation regarding other glucocorticoid doses and preparations. Numerous studies have been performed to investigate the effects of steroid. The purpose of this paper is to evaluate these studies in order to elucidate the beneficial and harmful effects of steroid on the prevention and treatment of BPD.
Highlights
Despite significant progress in the treatment of preterm neonates, bronchopulmonary dysplasia (BPD) continues to be a major cause of neonatal morbidity
In 2010, the American Academy of Pediatrics (AAP) revised policy statement regarding the use of postnatal corticosteroids for prevention or treatment of chronic lung disease in preterm infants, concluded that high-dose dexamethasone (0.5 mg/kg/day) does not seem to confer additional therapeutic benefit over lower doses, and is not recommended
Whatever the underlying explanation(s) for the observed differences in short- and long-term outcomes may be, further randomized controlled trials (RCTs) are needed to answer the many remaining questions, including whether lower doses of dexamethasone can avoid previously observed adverse effects, whether hydrocortisone is efficacious for extubation, whether specific groups of infants may derive particular benefit from hydrocortisone therapy, and whether the incidence of spontaneous gastrointestinal perforation during early glucocorticoid administration can be decreased by avoiding concomitant indomethacin or ibuprofen therapy and/or by monitoring cortisol concentrations
Summary
Despite significant progress in the treatment of preterm neonates, bronchopulmonary dysplasia (BPD) continues to be a major cause of neonatal morbidity. Studies in last one and half decade have seriously questioned the routine use International Journal of Pediatrics of steroids especially high-dose dexamethasone due to its long-term effect on neurodevelopment. In 2010, the American Academy of Pediatrics (AAP) revised policy statement regarding the use of postnatal corticosteroids for prevention or treatment of chronic lung disease in preterm infants, concluded that high-dose dexamethasone (0.5 mg/kg/day) does not seem to confer additional therapeutic benefit over lower doses, and is not recommended. Despite AAP statement to limit the use of systemic dexamethasone especially high dose, seems reasonable considering it has proven adverse effect on neurodevelopment. If we can limit the systemic side effects of steroid in some way and can utilize its local anti-inflammatory effect on lung, it can be a very useful drug in management of new BPD. Budesonide has been tried as intratracheal instillation with or without surfactant as a vehicle and shown to reduce inflammatory marker in tracheal aspirates in initial clinical trials
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
