Decreased Use of Postnatal Corticosteroids in Extremely Preterm Infants without Increasing Chronic Lung Disease

Background: Postnatal corticosteroids are effective in preventing chronic lung disease in preterm infant. There are concerns that corticosteroid use may be associated with an increased risk of impaired neurodevelopment. Objective: To examine the effect of change in practice with the use of postnatal corticosteroids over an 8-year period in extremely preterm babies on the incidence of chronic lung disease (CLD) and cerebral palsy at 1 year of age. Methods: Babies of birth weight <1,000 g or gestational age <28 weeks admitted from 1997 to 2004 were included in this retrospective analysis. The study period was divided into two eras: group 1: 1997-2000, group 2: 2001-2004. Data were collected from the neonatal database, individual records and from the Growth and Development Unit. The outcome measure of CLD was defined as oxygen dependency at 36 weeks post-menstrual age. Data for postnatal corticosteroid usage were collected for the number of babies per year, and total dose. Results: 389 group 1 babies were compared to 368 group 2 babies. There was a significant decrease in the use of dexamethasone from 27% in group 1 to 13% in group 2 (p = 0.0001), and total dose - mg/kg (4.5 +/- 2.9 vs. 2.6 +/- 1.6, p = 0.0001). The incidence of CLD and need for home oxygen was similar between groups. The incidence of cerebral palsy reduced from 10.4% in group 1 to 6.6% in group 2, though this was not statistically significant (OR 0.63; 95% Cl 0.3, 1.2.). Conclusion: Decreased postnatal corticosteroid use had no impact on the incidence of CLD or need for home oxygen therapy. The trend towards a reduced rate of cerebral palsy requires further investigation. Copyright (c) 2008 S. Karger AG, Basel