Title:Current Concepts of Corticosteroids Use for the Prevention of Bronchopulmonary
Dysplasia
Volume: 19
Issue: 3
Author(s): Serafina Perrone*, Serena Orlando, Chiara Petrolini, Francesca Marinelli, Sabrina Moretti, Mara Corradi, Maurizio Giordano and Giuseppe De Bernardo
Affiliation:
- Department of Medicine and Surgery, Neonatology Unit, AOUP, University of Parma, Parma, Italy
Keywords:
Bronchopulmonary dysplasia, preterm newborns, corticosteroids, neonatal pulmonary medicine, oxygen, surfactant.
Abstract: Despite using antenatal steroids, surfactants and protective ventilation, bronchopulmonary
dysplasia (BPD) affects 10-89% of preterm infants. Since lung inflammation is central to the
BPD pathogenesis, postnatal systemic corticosteroids could reduce the risk of BPD onset in preterm
infants, but short and long-term adverse consequences have been underlined in literature after their
use (i.e., hyperglycaemia, hypertension, hypertrophic cardiomyopathy, growth failure, gastrointestinal
bleeding, cerebral palsy). Alternative therapeutic strategies such as postponing corticosteroid
administration, lowering the cumulative dose, giving pulse rather than continuous doses, or individualizing
the dose according to the respiratory condition of the infant have been proposed to avoid
their adverse effects. Dexamethasone remains the first-line drug for newborns with severe pulmonary
disease beyond the second to the third week of life. Hydrocortisone administration in very preterm
infants does not appear to be associated with neurotoxic effects, even if its efficacy in preventing
and treating BPD has yet been clearly demonstrated. Alternative methods of corticosteroid administration
seem promising. A positive effect on BPD prevention occurs when budesonide is nebulized
and intratracheally instilled with a surfactant, but more data are required to establish safety
and efficacy in preterm newborns. Additional studies are still needed before the chronic lung disease
issue, and its related challenges can be solved.
