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Update on Postnatal Corticosteroids to Prevent or Treat Bronchopulmonary Dysplasia.
- Source :
-
American journal of perinatology [Am J Perinatol] 2019 Jul; Vol. 36 (S 02), pp. S58-S62. Date of Electronic Publication: 2019 Jun 25. - Publication Year :
- 2019
-
Abstract
- Bronchopulmonary dysplasia (BPD) is a major complication of premature birth that significantly affects mortality and long-term morbidity in numerous immature infants. Corticosteroids are particularly suitable for treating BPD, as lung inflammation is central to its pathogenesis. Corticosteroids have considerable, fast beneficial effects on lung function in premature infants with lung disease, but they are also associated with several serious adverse effects, which may have a detrimental impact on long-term outcome. Dexamethasone is the most often used corticosteroid for systemic administration. Despite its value in preventing and treating BPD, its use is associated with several alarming short-term effects and, worst of all, with an increased rate of cerebral palsy in the long term. Dexamethasone nonetheless remains an important therapeutic option for infants with severe lung disease beyond the second to third week of life. Hydrocortisone is an important alternative to dexamethasone, as its use does not appear to be associated with any neurotoxic effects. Its efficacy in the prevention and treatment of BPD has yet to be clearly demonstrated, however. Inhaled corticosteroids might reduce lung inflammation with fewer systemic adverse effects; however, a recent, large randomized trial showed that inhaled budesonide was associated with an excess mortality, despite its beneficial respiratory effects. In another study, instilling budesonide together with surfactant in the trachea of intubated infants with severe respiratory distress appeared safe and achieved a significant reduction in the rate of BPD at 36 postmenstrual weeks. This important finding needs to be confirmed in a larger trial currently underway.<br />Competing Interests: None declared.<br /> (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)
- Subjects :
- Administration, Inhalation
Adrenal Cortex Hormones administration & dosage
Bronchopulmonary Dysplasia mortality
Budesonide therapeutic use
Dexamethasone therapeutic use
Humans
Hydrocortisone therapeutic use
Infant
Infant, Newborn
Meta-Analysis as Topic
Pulmonary Surfactants therapeutic use
Adrenal Cortex Hormones therapeutic use
Bronchopulmonary Dysplasia drug therapy
Bronchopulmonary Dysplasia prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1098-8785
- Volume :
- 36
- Issue :
- S 02
- Database :
- MEDLINE
- Journal :
- American journal of perinatology
- Publication Type :
- Academic Journal
- Accession number :
- 31238361
- Full Text :
- https://doi.org/10.1055/s-0039-1691802