Korean J Perinatol.  2015 Dec;26(4):321-328. 10.14734/kjp.2015.26.4.321.

Characteristics of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants according to the Timing of Dexamethasone Administration

• Lee HY
• Lee HJ
• Koh JW
• Song IG
• Kim SY
• Jung YH
• Shin SH
• Choi CW
• Kim EK
• Kim HS
• Kim BI
• Choi JH

• KMID: 2164187
• DOI: http://doi.org/10.14734/kjp.2015.26.4.321

Abstract

PURPOSE
Corticosteroids has been used for treatment and prophylaxis of bronchopulmonary dysplasia (BPD) in preterm infants. However, administration of corticosteroids could be delayed due to its potential harmful effects on neurodevelopment. The aim of this study was to evaluate the adequate dexamethasone administration timing in very low birth weight infants.
METHODS
Medical records of 56 VLBW infants who were admitted to neonatal intensive care unit of Seoul National University Children's Hospital and Seoul National University Bundang Hospital between January 2008 and September 2014 were collected retrospectively. Study population were divided into early administration group (dexamethasone administration before 4 weeks of postnatal days) and late administration group (after 4 weeks) and respiratory morbidities were compared between groups.
RESULTS
There were no significant differences in clinical characteristics between early administration group (n=30) and late administration group (n=26). Respiratory severity score and oxygen needs at 7 days after birth and before administering dexamethasone were comparable. Extubation was done earlier postnatal days in early administration group. Incidence of severe BPD was higher in the late administration group. There was no significant difference in diagnosed with cerebral palsy (CP) at 12 months of corrected age. When adjusting for multiple risk factors, administration of dexamethasone 4 weeks after birth and severe of BPD showed a significant association (adjusted OR 17.14 [1.29-227.52], P=0.031).
CONCLUSION
Administration of dexamethasone in order to minimize ventilator care and to reduce severe BPD might be done between 1 week and 4 weeks after birth in very low birth weight infants.

Keyword

Very low birth weight; Bronchopulmonary dysplasia; Dexamethasone; Cerebral palsy

MeSH Terms

Adrenal Cortex Hormones
Bronchopulmonary Dysplasia*
Cerebral Palsy
Dexamethasone*
Humans
Incidence
Infant*
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight*
Intensive Care, Neonatal
Medical Records
Oxygen
Parturition
Retrospective Studies
Risk Factors
Seoul
Ventilators, Mechanical
Adrenal Cortex Hormones
Dexamethasone
Oxygen

Reference

References

1. Northway WH Jr, Rosan RC, Porter D. Pulmonary disease following respiratory therapy of hyaline membrane disease: bronchopulmonary dysplasia. N Engl J Med. 1967; 276:357–68.

2. Jobe AH. The new BPD: an arrest of lung development. Pediatr Res. 1999; 66:641–3.

3. Hodgman JE. Relationship between Wilson-Mikity syndrome and the new bronchopulmonary dysplasia. Pediatrics. 2003; 112:1414–5.

4. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, et al. Trends in neonatal morbidity and mortality for very low birth weight infants. Am J Obstet Gynecol. 2007; 196:147.e1–8.

5. Choi CW, Kim BI, Kim EK, Song ES, Lee JJ. Incidence of bronchopulmonary dysplasia in Korea. J Korean Med Sci. 2012; 27:914–21.

6. Ehrenkranz RA, Walsh MC, Vohr BR, Jobe AH, Wright LL, Fanaroff AA, et al. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics. 2005; 116:1353–60.

7. Kim BI. Recent progress in the understanding of clinical characteristics, epidemiology, and pathogenesis of new bronchopulmonary dysplasia. Korean J Pediatr. 2009; 52:6–13.

8. Finer NN, Powers RJ, Ou CH, Durand D, Wirtschafter D, Gould JB, et al. Prospective evaluation of postnatal steroid administration: a 1-year experience from the California Perinatal Quality Care Collaborative. Pediatrics. 2006; 117:704–13.

9. Halliday HL, Ehrenkranz RA, Doyle LW. Early postnatal (<96 hours) corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2003; 1:CD001146.

10. American Academy of Pediatris. Policy Statement-postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia. Pediatrics. 2010; 126:800–13.

11. Jobe AH, Bancalari E. NICHD/NHLBI/ORD workshop summary-Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001; 163:1723–9.

12. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Annals of surgery. 1978; 187:1–7.

13. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am. J. Infect. Control. 1988; 16:128–40.

14. John PC, Eric CE, Anne RH, Ann RS. Manual of Neonatal Care. 6th ed.North American: Lippincott Williams & Wilkins;2007. p. 379.

15. Kitchen WH, Olinsky A, Doyle LW, Ford GW, Murton LJ, Slonim L, et al. Respiratory health and lung function in 8-year-old children of very low birth weight: a cohort study. Pediatrics. 1992; 89:1151–8.

16. Greenough A, Giffin FJ, Yüksel B. Respiratory morbidity in preschool children born prematurely. Relationship to adverse neonatal events. Acta Paediatr. 1996; 85:772–7.

17. Giacoia GP, Venkataraman PS, West-Wilson KI, Faulkner MJ. Follow-up of school-age children with bronchopulmonary dysplasia. J Pediatr. 1997; 130:400–8.

18. Korhonen P, Koivisto AM, Ikonen S, Laippala P, Tammela O. Very low birthweight, bronchopulmonary dysplasia and health in early childhood. Acta Paediatr. 1999; 88:1385–91.

19. Evans M1. Palta M, Sadek M, Weinstein MR, Peters ME. Associations between family history of asthma, bronchopulmonary dysplasia, and childhood asthma in very low birth weight children. Am J Epidemiol. 1998; 148:460–6.

20. Schaubel D, Johansen H, Dutta M, Desmeules M, Becker A, Mao Y. Neonatal characteristics as risk factors for preschool asthma. J Asthma. 1996; 33:255–64.

21. Brostrom EB, Thunqvist P, Adenfelt G, Borling E, Katz-Salamon M. Obstructive lung disease in children with mild to severe BPD. Respir Med. 2010; 104:362–70.

22. Mammel MC, Green TP, Johnson DE, Thompson TR. Controlled trial of dexamethasone therapy in infants with bronchopulmonary dysplasia. Lancet. 1983; 1:1356–58.

23. Dexamethasone therapy in neonatal chronic lung disease: an international placebocontrolled trial. Collaborative Dexamethasone Trial Group. Pediatrics. 1991; 88:421–27.

24. Doyle LW, Ehrenkranz RA, Halliday HL. Early (< 8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2014; 5:CD001146.

25. Halliday HL, Ehrenkranz RA, Doyle LW. Late (>7 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2009; 1:CD001145.

26. Doyle LW, Ehrenkranz RA, Halliday HL. Dexamethasone treatment in the first week of life for preventing bronchopulmonary dysplasia in preterm infants: a systematic review. Neonatology. 2010; 98:217–24.

27. Walsh MC, Yao Q, Horbar JD, Carpenter JH, Lee SK, Ohlsson A. Changes in the use of postnatal steroids for bronchopulmonary dysplasia in 3 large neonatal networks. Pediatrics. 2006; 118:e1328–35.

28. Committee on Fetus and Newborn. Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants. Pediatrics. 2002; 109:330–8.

29. Jefferies AL. Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants. Paediatr Child Health. 2012; 17:573–4.