Submitting/Presenting Author

Christian OliverosFollow

Presenter Status

Resident/Psychology Intern

Abstract Type

Research

Primary Mentor

Dr. Alain Cuna

Start Date

14-5-2021 11:30 AM

End Date

14-5-2021 1:30 PM

Presentation Type

Poster Presentation

Description

Background: Although a short course of steroids maybe beneficial in infants at high risk for bronchopulmonary dysplasia, response to treatment is variable. In infants with persistent lung disease despite initial treatment, repeat courses of steroids have been described but not well-studied. This 10-year observational study from a single tertiary referral center evaluates the effectiveness and safety of repeat steroid treatment for bronchopulmonary dysplasia.

Objectives/Goal: To describe effectiveness of repeat dexamethasone treatment for bronchopulmonary dysplasia (BPD) and to evaluate potential detrimental effects on growth and neurodevelopment.

Methods/Design: This was a 10-year single-center observational study of infants <30 >weeks’ gestational age at birth treated with 1 or 2 courses of systemic dexamethasone for BPD. Effectiveness was defined as step-down in mode of respiratory support from baseline by end of treatment. Adverse effects on growth z-scores and Bayley-III neurodevelopment scores were analyzed and compared to a cohort of untreated controls.

Results: We identified 132 infants treated with dexamethasone for BPD, 52 of whom received repeat dexamethasone treatment. Sixty-nine of 132 infants (52%) treated with an initial course of dexamethasone were successfully extubated to non-invasive ventilatory support, while 20 of 52 infants (38%) treated with repeat dexamethasone achieved step-down in mode of respiratory support. Growth trajectory over time did not differ among infants treated with 1 or 2 courses of dexamethasone compared with untreated controls (weight: P = 0.23, length: P = 0.68, and head circumference: P = 0.77). Repeat dexamethasone treatment was associated with lower Bayley cognitive scores (76.7 ± 12.6 vs 86.4 ± 13.3, P=0.02) and motor scores (71.7 ± 21.6 vs 84.6 ± 13.1, P = 0.01) compared to untreated controls, but this association was no longer significant after adjusting for confounders.

Conclusions: A second course of dexamethasone for BPD was less effective in weaning respiratory support compared to the initial course but was not associated with detrimental effects on growth or neurodevelopment.

Additional Files

Effectiveness and safety of repeat dexamethasone for bronchopulmo.pdf (255 kB)
Abstract

Fig 1 Flowchart.pptx (49 kB)
Flowchart showing outcomes of infants treated with dexamethasone.

Fig 2.pptx (358 kB)
Changes in growth parameters from birth to discharge.

Table 1.pptx (144 kB)
Baseline demographics and clinical outcomes of the study population.

Table 2.pptx (122 kB)
Characteristics of intubated infants at time of treatment with first or second course of dexamethasone.

Table 3.pptx (86 kB)
Comparison of neurodevelopmental outcomes among steroid-treated infants and untreated controls.

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May 14th, 11:30 AM May 14th, 1:30 PM

Effectiveness and safety of repeat dexamethasone for bronchopulmonary dysplasia

Background: Although a short course of steroids maybe beneficial in infants at high risk for bronchopulmonary dysplasia, response to treatment is variable. In infants with persistent lung disease despite initial treatment, repeat courses of steroids have been described but not well-studied. This 10-year observational study from a single tertiary referral center evaluates the effectiveness and safety of repeat steroid treatment for bronchopulmonary dysplasia.

Objectives/Goal: To describe effectiveness of repeat dexamethasone treatment for bronchopulmonary dysplasia (BPD) and to evaluate potential detrimental effects on growth and neurodevelopment.

Methods/Design: This was a 10-year single-center observational study of infants <30>weeks’ gestational age at birth treated with 1 or 2 courses of systemic dexamethasone for BPD. Effectiveness was defined as step-down in mode of respiratory support from baseline by end of treatment. Adverse effects on growth z-scores and Bayley-III neurodevelopment scores were analyzed and compared to a cohort of untreated controls.

Results: We identified 132 infants treated with dexamethasone for BPD, 52 of whom received repeat dexamethasone treatment. Sixty-nine of 132 infants (52%) treated with an initial course of dexamethasone were successfully extubated to non-invasive ventilatory support, while 20 of 52 infants (38%) treated with repeat dexamethasone achieved step-down in mode of respiratory support. Growth trajectory over time did not differ among infants treated with 1 or 2 courses of dexamethasone compared with untreated controls (weight: P = 0.23, length: P = 0.68, and head circumference: P = 0.77). Repeat dexamethasone treatment was associated with lower Bayley cognitive scores (76.7 ± 12.6 vs 86.4 ± 13.3, P=0.02) and motor scores (71.7 ± 21.6 vs 84.6 ± 13.1, P = 0.01) compared to untreated controls, but this association was no longer significant after adjusting for confounders.

Conclusions: A second course of dexamethasone for BPD was less effective in weaning respiratory support compared to the initial course but was not associated with detrimental effects on growth or neurodevelopment.