Flashcards in Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants Deck (14):
What is chronic lung disease (previously bronchopulmonary dysplasia)?
Oxygen required at 36wks PMA with respiratory symptoms and compatible changes on CXR
What percentage of surviving infants born <33 weeks GA require oxygen at 36wks PMA?
What are the benefits of early corticosteroids (before seven days of life)?
1. Earlier extubation
2. Reduced need for oxygen at 36 wks GA
What are the adverse effects of early corticosteroids?
3. GI hemorrhage
4. GI perforation
What is the overall recommendation regarding early corticosteroid therapy?
The benefits of early corticosteroid therapy do not appear to outweight the adverse effects
What are the benefits of late dexamethasone (>7d of life)?
1. Decreased mortality at 28d
2. Reduced rate of CLD at 36wks PMA
3. Reduced combined outcome of death or CLD at 36 weks GA
4. Decreased failure to extubate within 7d
5. Decreased number of infants discharged home on oxygen
What are the adverse effects of late corticosteroids?
3. Hypertrophic cardiomyopathy
4. Severe ROP
5. No effect on CP or neurosensory disability
What is the overall recommendation regarding late corticosteroid therapy?
Late dexamethasone appeared to have both beneficial and harmful effects, it was suggested that its use be reserved for infants who could not be weaned from mechanical ventilation
What is the evidence for low dose dexamethasone?
At present, there is insufficient evidence to demonstrate the safety of routine low-dose dexamethasone use.
What is the evidence for those at high risk of CLD?
If the rate of CLD was >65%, dexamethasone treatment appeared to decrease the rate of death or cerebral palsy. This suggests that dexamethasone may be beneficial to infants at very high risk of CLD but this has not yet been studied in clinical trials
What is the evidence for hydrocortisone therapy?
Overall, although hydrocortisone may be a promising alternative to dexamethasone for treating babies with CLD or prolonged ventilator dependence, there is no evidence at this time to show that it is effective or safe.
What is the evidence for inhaled corticosteroid?
There is currently little evidence to support the routine use of inhaled corticosteroids for the prevention or treatment of CLD. Inhaled corticosteroids do not appear to offer significant benefits over systemic corticosteroids for the treatment of infants who remain ventilator-dependent
What is the risk of adrenal insufficiency?
Risk in preterm infants that have been on corticosteroids