Oral prednisolone in infants with oxygen-dependent BPD

Inflammation plays a central role in the pathogenesis of bronchopulmonary dysplasia, (BPD). Therefore, intravenous and oral steroids have been used as anti-inflammatory agents to alter the course of lung disease in premature infants. Dexamethasone treatment has been well studied and has been found effective in weaning infants off mechanical ventilation when given moderately early (7–14 days of age) or late (14–28 days of age) in the initial nursery course, although it has not been shown to reduce total days of hospitalization, duration of supplemental oxygen therapy or incidence of BPD. The use of dexamethasone in preterm very low birth weight infants to prevent BPD has not been recommended because of a lack of long-term pulmonary benefits and clear increases in gastrointestinal and neurologic complications. Clinical practitioners have developed a practice of administering a short course of oral steroids (5–10 days) in infants >36 weeks’ post menstrual age (PMA) with oxygen-dependent BPD in an effort to wean them off of supplemental oxygen, but the effectiveness of this therapy has not been studied in detail.
Thus, an American group has retrospectively analyzed the data collected at the John Dempsey Hospital neonatal intensive care unit, in order to determine if oral prednisolone, administered after 36 weeks’ PMA, would help infants with oxygen-dependent BPD wean off supplemental oxygen.
Among the infants with BPD studied, 131 infants received oral prednisolone and 254 did not; there was no significant difference in race, gender, birth weight, or gestational age between the two groups. Infants in the oral prednisolone group were more likely to have received previous dexamethasone therapy, had longer duration of mechanical ventilation and of hospital stay, and were more likely to be discharged from the hospital on oxygen. Of those in the oral prednisolone group, 63% responded to treatment. The oral prednisolone-responsive group had a lower pulmonary acuity score and significantly lower capillary PCO2 values compared with the oral prednisolone-nonresponsive group. Statistical analysis showed that a pulmonary acuity score value ≤0.5 (sensitivity 20%, specificity 97.4%) and a capillary PCO2 value <48.5 mmHg (sensitivity 50%, specificity 89.7%)were positive predictors of response to oral prednisone. There was no evidence that a repeated administration of oral prednisolone would determine any further benefits.
In conclusion, the results of this study provided evidence that oral prednisolone therapy is effective only in selected patients with BPD. In particular, the patient most likely to benefit from a short course of oral prednisolone therapy is an infant with oxygen-dependent BPD who has a capillary PCO2 <48.5 mmHg or a pulmonary acuity score <0.50. In addition, if a single course of prednisolone fails to help wean off oxygen, there is no clear benefit of using multiple courses. These results may provide some indications for the late use of oral prednisolone in infants with BPD; however, further studies are required to verify the effectiveness of this practice.

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