Retrospective Analysis of Short-Term Respiratory Outcomes of Three Different Steroids Used in Clinical Practice in Intubated Preterm Infants

Abstract Objective This study aimed to compare short-term respiratory outcomes of three steroids (dexamethasone, hydrocortisone, and methylprednisolone) to facilitate extubation by improving respiratory status in preterm infants. Study Design This is a retrospective, single-center, cohort study of 98 intubated preterm infants ≤346/7 weeks' gestation, admitted to a 64-bed, level III neonatal intensive care unit at the Women & Children's Hospital of Buffalo, Buffalo, NY, between 2006 and 2012, who received a short course of low-dose steroids for lung disease after first week of life. Results Study infants received dexamethasone (34%), hydrocortisone (44%), or methylprednisolone (22%) based on clinical team preference. By day 7 after initiation of steroids, extubation occurred in 59, 44, and 41%, respectively, in infants on dexamethasone, hydrocortisone, and methylprednisolone (p = 0.3). The mean respiratory severity score (RSS = fraction of inspired oxygen × mean airway pressure), a quantitative measure of respiratory status, decreased by 44% for all infants and by 59% in the dexamethasone group by day 7. Conclusion Steroids improved short-term respiratory outcomes in all infants (RSS and extubation); by day 7, dexamethasone treatment was associated with the greatest decrease in RSS. Additional prospective, randomized trials of short-course low-dose steroids are warranted to substantiate these findings to guide clinical decision making and in evaluating differential steroid effects on long-term neurodevelopmental outcomes.

• Publication year

  2019

• Venue

  American Journal of Perinatology

• Publication date

  2019-08-05

• Fields of study

  Medicine

• Identifiers
  DOI 10.1055/s-0039-1694004PMID 31382299
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Systemic Hydrocortisone To Prevent Bronchopulmonary Dysplasia in preterm infants (the SToP-BPD study): statistical analysis plan

  2018cited by this paper
• Inhaled and systemic steroid exposure and neurodevelopmental outcome of preterm neonates

  2018cited by this paper
• Interdisciplinary Care of Children with Severe Bronchopulmonary Dysplasia

  2017cited by this paper
• Systemic corticosteroid regimens for prevention of bronchopulmonary dysplasia in preterm infants.

  2017cited by this paper
• Association between Postnatal Dexamethasone for Treatment of Bronchopulmonary Dysplasia and Brain Volumes at Adolescence in Infants Born Very Preterm

  2014cited by this paper
• Early life intervention with glucocorticoids has negative effects on motor development and neuropsychological function in 14-17 year-old adolescents.

  2013cited by this paper
• Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants.

  2012cited by this paper
• Inhaled Nitric Oxide in Preterm Infants Undergoing Mechanical Ventilation

  2012cited by this paper
• Systemic hydrocortisone to prevent bronchopulmonary dysplasia in preterm infants (the SToP-BPD study); a multicenter randomized placebo controlled trial

  2011cited by this paper
• Dexamethasone Treatment after the First Week of Life for Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review

  2010cited by this paper
• Postnatal Corticosteroids to Prevent or Treat Bronchopulmonary Dysplasia

  2010cited by this paper
• Impact of Postnatal Corticosteroid Use on Neurodevelopment at 18 to 22 Months' Adjusted Age: Effects of Dose, Timing, and Risk of Bronchopulmonary Dysplasia in Extremely Low Birth Weight Infants

  2009cited by this paper
• Corticosteroid physiology and principles of therapy

  2008cited by this paper
• Postnatal corticosteroids for bronchopulmonary dysplasia.

  2007cited by this paper
• Inhaled nitric oxide in preterm infants undergoing mechanical ventilation.

  2006cited by this paper
• Low-Dose Dexamethasone Facilitates Extubation Among Chronically Ventilator-Dependent Infants: A Multicenter, International, Randomized, Controlled Trial

  2006cited by this paper
• Pathology of bronchopulmonary dysplasia.

  2006cited by this paper
• The effects of early postnatal dexamethasone therapy on pulmonary outcome in premature infants with respiratory distress syndrome: A two‐year follow‐up study

  2005cited by this paper
• Short‐ and long‐term effects of neonatal glucocorticoid therapy: is hydrocortisone an alternative to dexamethasone?

  2003cited by this paper
• Randomized controlled trial of three different doses of aerosol beclomethasone versus systemic dexamethasone to promote extubation in ventilated premature infants

  2003cited by this paper
• Delayed (>3 weeks) postnatal corticosteroids for chronic lung disease in preterm infants.

  2003cited by this paper
• Delayed (>3 weeks) postnatal corticosteroids for chronic lung disease in preterm infants.

  2003cited by this paper
• Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants.

  2002cited by this paper
• Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants.

  2002cited by this paper
• Adverse effects of early dexamethasone treatment in extremely-low-birth-weight infants. National Institute of Child Health and Human Development Neonatal Research Network.

  2001cited by this paper
• Postnatal steroids and neurodevelopmental outcomes: a problem in the making.

  2001cited by this paper
• Glucocorticoids, inflammation and the perinatal lung.

  2001cited by this paper
• Adverse effects of early dexamethasone treatment in extremely-low-birth-weight infants.

  2001cited by this paper
• 超出生体重児に対する早期デキサメサゾン投与の有用性 : National Institute of Child Health and Human Development Neonatal research Network報告 (海外誌掲載論文の和文概要とそれに対するコメント)

  2001cited by this paper
• Methylprednisolone, an alternative to dexamethasone in very premature infants at risk of chronic lung disease

  2000cited by this paper
• Postnatal corticosteroids in preterm infants: Systematic review of effects on mortality and motor function

  2000cited by this paper
• Controlled trial of dexamethasone in respirator-dependent infants with bronchopulmonary dysplasia.

  1985cited by this paper

• Do Postnatal Corticosteroids Negatively Impact the Neurodevelopmental Outcomes of Extremely Preterm Infants?

  2025cites this paper
• Salivary cortisol is not associated with dexamethasone response in preterm infants with evolving bronchopulmonary dysplasia

  2024cites this paper
• Pharmacotherapy of BPD: Current status & future perspectives.

  2023cites this paper
• Postnatal Steroids Use for Bronchopulmonary Dysplasia in a Quaternary Care NICU

  2023cites this paper
• Let’s Talk about Dex: When do the Benefits of Dexamethasone for Prevention of Bronchopulmonary Dysplasia Outweigh the Risks?

  2022cites this paper
• Dexamethasone Alters Tracheal Aspirate T-Cell Cytokine Production in Ventilated Preterm Infants

  2021cites this paper
• Oxygen and Steroids Affect the Regulatory Role of Natriuretic Peptide Receptor-C on Surfactant Secretion by Type II Cells.

  2021cites this paper
• Efficacy of late postnatal dexamethasone on weaning from invasive mechanical ventilation in extreme premature infants

  2021cites this paper
• Postnatal steroid management in preterm infants with evolving bronchopulmonary dysplasia

  2021cites this paper
• Hydrocortisone and bronchopulmonary dysplasia: variables associated with response in premature infants

  2020cites this paper