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Name of Media:

Early (< 8 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants

Author(s):

Lex W Doyle, Jeanie L Cheong, Richard A Ehrenkranz, Henry L Halliday

Publisher or Source:

Cochrane Database of Systematic Reviews

Type of Media:

Medical Journal

Media Originally for:

Critical Care Physicians

Country of Origin:

Australia

Primary Focus of Media:

Pre-Use of PICS Designation

COVID-19 Related:

No

Description:

Review objective: To determine the relative benefits and harms of treatment with drugs that suppress inflammation, called corticosteroids, given to babies born too early during the first week after birth to prevent lung injury, known as bronchopulmonary dysplasia (sometimes also called chronic lung disease).

Background: Corticosteroids can reduce lung inflammation in newborn babies with bronchopulmonary dysplasia but may produce major adverse effects. Bronchopulmonary dysplasia is a major problem for newborn babies in neonatal intensive care units. Persistent inflammation of the lungs is the most likely cause. Corticosteroid drugs have been used to prevent or treat bronchopulmonary dysplasia through their strong anti‐inflammatory effects.

Study characteristics: We reviewed all clinical trials in preterm babies in which corticosteroids had been given as a medication during the first week after birth, and from which data on the rate of bronchopulmonary dysplasia later in the newborn period were available.

Key results: This review of trials revealed that the benefits of giving systemic corticosteroids to infants starting up to seven days after birth may not outweigh the known adverse effects. However, a particular corticosteroid called hydrocortisone shows promise in improving short‐term outcomes without adversely affecting long‐term neurodevelopment. Beneficial effects of systemic corticosteroids overall included shorter time on the ventilator and less bronchopulmonary dysplasia, but adverse effects included higher blood pressure, bleeding from the stomach or bowel, perforation of the bowel, excessive glucose in the bloodstream, and increased risk of cerebral palsy at follow‐up, particularly in those treated with dexamethasone ‐ another type of corticosteroid. Early use of corticosteroids, especially dexamethasone, to treat or prevent bronchopulmonary dysplasia should be curtailed until additional research has been performed.

Quality of evidence: Overall, the quality of evidence supporting our conclusions was high.

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