Late (after seven days) systemic postnatal corticosteroids for preventing bronchopulmonary dysplasia in preterm infants
Review question: To determine the relative benefits and harms associated with treatment consisting of drugs that suppress inflammation, called corticosteroids, given after the first week after birth to prevent or treat lung injury, known as bronchopulmonary dysplasia (sometimes also called chronic lung disease), in babies born too early.
Background: Corticosteroids can reduce lung inflammation in newborns with bronchopulmonary dysplasia but may cause major adverse effects. Bronchopulmonary dysplasia is a major problem for newborn babies in neonatal intensive care units. It is associated with both a higher death rate and worse long-term outcomes among survivors. Persistent inflammation of the lungs is the most likely cause of bronchopulmonary dysplasia. Corticosteroid drugs have strong anti-inflammatory effects and so have been used to prevent or to treat bronchopulmonary dysplasia, particularly in babies who cannot be weaned from assisted ventilation.
Study characteristics: We reviewed all clinical trials in preterm babies that gave corticosteroids after the first week after birth and provided data on rates of bronchopulmonary dysplasia later in the newborn period.
Key results: This review of trials indicates that giving corticosteroids to infants at least seven days after birth produces short-term benefits in reducing the need for assisted ventilation and the rate of bronchopulmonary dysplasia, perhaps also reducing death during the first 28 days of life. However, high doses in particular are associated with short-term side effects such as bleeding from the stomach or bowel, higher blood pressure, and difficulty tolerating glucose. In contrast with early use of corticosteroids (in the first week of life), we found little evidence of long-term complications and uncertainty regarding long-term problems. It seems wise to limit late use of corticosteroids to babies who cannot be weaned from assisted ventilation, and to minimise the dose and duration of any course of treatment.
Quality of evidence: Overall the quality of evidence supporting our conclusions was high.