Extended course of prednisolone in infants with severe bronchopulmonary dysplasia

Abstract

Background: There are few published data on the efficacy and safety of prednisolone in preterm infants with bronchopulmonary dysplasia (BPD).

Aims: To describe the use of chronic prednisolone therapy in a population of infants with severe BPD, examine potential benefits on respiratory status, and document potential effects on growth.

Study design: Single-center retrospective cohort study.

Subjects: Preterm infants who had received ≥30 days of prednisolone for the treatment of severe BPD.

Outcome measures: Weekly changes in Pulmonary Severity Score (PSS), as well as weekly changes in weight, length, and head circumference during prednisolone therapy.

Results: Forty-three infants (mean birth weight 729 g; mean gestational age 26 weeks) were identified. The average age at start of prednisolone treatment was 42.5 ± 5.9 weeks; while the median duration and median cumulative dose of prednisolone therapy were 67 (IQR 57-107) days and 61.3 (IQR 39.9-93.3) mg/kg, respectively. PSS decreased after 1 week of prednisolone therapy (mean difference, 0.19; 95% Cl, 0.01 to 0.37; p = 0.03). No further reduction in PSS was noted despite continued treatment. Length z-scores decreased after 4 weeks of continued treatment (mean difference 0.6; 95% CI 0.01 to 1.1; P = 0.04), while weight and head circumference did not change.

Conclusions: In one of the first reports on prednisolone therapy for severe BPD, we describe that long-term prednisolone is associated with modest short-term improvement in PSS, but impairs linear growth. Our results suggest a risk-benefit profile of prednisolone that does not favor long-term use in infants with severe BPD.

Keywords: Bronchopulmonary dysplasia; Corticosteroids; Growth; Outcome; Prednisolone; Prematurity.