Abstract
Corticosteroids are administered to ventilator dependent infants with bronchopulmonary dysplasia (BPD) to improve respiratory function and facilitating extubation. Acutely, however, growth impairment can occur as a side effect of such therapy. We aimed to determine the effect of corticosteroids on postnatal growth during the entire neonatal intensive care unit (NICU) admission. A whole population study of extremely preterm infants with BPD was undertaken. Corticosteroid therapy was classified as treatment with dexamethasone or hydrocortisone for a least five consecutive days. Growth was calculated as the difference in weight and head circumference z-score from birth to discharge. Six thousand, one hundred and four infants with BPD were included of whom 28.3% received postnatal corticosteroids. Infants receiving corticosteroids were less mature (GA 25.0 vs. 26.3weeks) and of lower birthweight (0.70 vs. 0.84kg) than those not receiving treatment. There were no significant differences between those who did and did not receive corticosteroids in weight gain (p=0.61) or head circumference growth (p=0.33) from birth to discharge. Single vs. multiple courses of postnatal corticosteroids did not result in significant differences in weight (p=0.62) or head circumference (p=0.13) growth. Postnatal corticosteroid treatment did not affect the longer term growth of preterm infants with BPD.
Highlights
Born infants with pulmonary insufficiency often require invasive mechanical ventilation
Recent advances in neonatal care and specific targeting of nutritional therapies, with parenteral nutrition and high enteral energy intake, have, resulted in improved postnatal growth and we have recently described such an effect in infants with bronchopulmonary dysplasia (BPD) [1]
Postnatal corticosteroid treatment was classified as administration of dexamethasone or hydrocortisone for more than five consecutive days during neonatal intensive care unit (NICU) admission, as this was longer than the course of treatment usually prescribed to prevent post extubation stridor and the shortest course to reduce side-effects in infants treated for chronic lung disease of prematurity
Summary
Born infants with pulmonary insufficiency often require invasive mechanical ventilation. Infants with BPD can be at risk of postnatal growth failure due to their high metabolic demands, hyperoxic state and increased energy expenditure secondary to pulmonary pathology. Recent advances in neonatal care and specific targeting of nutritional therapies, with parenteral nutrition and high enteral energy intake, have, resulted in improved postnatal growth and we have recently described such an effect in infants with BPD [1]. Could be adversely affected by corticosteroids which are often prescribed to infants with evolving/established BPD with the aim of improving their respiratory status and facilitating successful extubation especially in those ventilated for prolonged periods. Corticosteroid administration has recently been reported to have had no adverse effects on postnatal weight gain from birth to discharge in a cohort of preterm infants born at less than 32 weeks of gestation, with better postnatal weight gain exhibited in infants receiving corticosteroids who did not go on to
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