Respiratory effects of prolonged prednisolone use in infants with evolving and established Bronchopulmonary dysplasia. (May 2021)

• Record Type: Journal Article
• Authors: Liviskie, Caren; Vesoulis, Zachary; Zeller, Brandy; Rao, Rakesh; McPherson, Christopher
• Is Part Of: Early human development. Volume 156(2021)
• Publication Date: 2021-05
• Subjects: BPD bronchopulmonary dysplasia -- CPAP continuous positive airway pressure -- FiO2 fraction of inspired oxygen -- LPM liters per minute -- NICHD National Institute of Child Health and Human Development -- NICU neonatal intensive care unit -- OFC occipital frontal circumference -- PMA post-menstrual age -- PSS pulmonary severity score -- SGA small for gestational age; Bronchopulmonary dysplasia -- Corticosteroids -- Infant -- Prednisolone -- Prematurity; Fetus -- Periodicals; Neonatology -- Periodicals; Prenatal influences -- Periodicals; 612.65
• DOI: 10.1016/j.earlhumdev.2021.105344
• Languages: English
• ISSNs: 0378-3782

Abstract

Abstract: Background: Current literature focuses on systemic corticosteroids for prevention of bronchopulmonary dysplasia (BPD) in preterm infants with limited data on use for pulmonary disease after the first month of life. Prednisolone may be a reasonable option for late treatment given its desirable pharmacologic properties and use in other pediatric disease states. Aims: To characterize a premature population that received an extended prednisolone course and determine the effect on respiratory and anthropometric outcomes over time. Study design: Single-center, retrospective study. Subjects: Preterm infants who received ≥30 days of prednisolone or methylprednisolone for treatment of respiratory complications following preterm birth. Outcomes measures: Assessment of pulmonary severity score (PSS), weight, length, and occipital frontal circumference weekly during the first 4 weeks of prednisolone and after discontinuation. Results: Thirty-four infants with a mean gestational age of 26.5 ± 2.5 weeks and birth weight of 846 ± 353 g were identified. Nine patients were on invasive mechanical ventilation and 25 patients were on non-invasive respiratory support at prednisolone initiation. Prednisolone was initiated at a mean post-menstrual age of 41.7 ± 5 weeks and a mean dose of 1.7 ± 0.6 mg/kg/day. A significant decrease in PSS was seen over time ( p < 0.001) without rebound following discontinuation. Eleven patients decreased the mode of respiratory support during prednisolone treatment. No significant impact in anthropometric outcomes were identified. Conclusion: Prolonged prednisolone use was associated with a sustained decrease in PSS without adverse effects on growth measurements. These results suggest potential benefit of prednisolone on respiratory outcomes in a subset of preterm infants. Highlights: Prednisolone was used for late respiratory complications of prematurity. Respiratory severity markers decreased over time with a prolonged treatment course. Rebound respiratory decompensation was not seen after prednisolone was discontinued. Adverse effects on anthropometric measures from prednisolone were not apparent.