Postnatal hydrocortisone treatment for chronic lung disease in the preterm newborn and long-term neurodevelopmental follow-up

Abstract

In contrast with the consensus about the benefits of maternal steroid treatment to accelerate fetal lung maturation, there is an ongoing debate about the pros and cons of postnatal corticosteroid administration to preterm-born infants. After initial reports in the nineteen eighties suggesting short-term benefits of steroids in ventilator-dependent children, dexamethasone (DXM) became the widely and almost exclusively used drug for preventing or treating chronic lung disease (CLD). One retrospective study examining the outcome of neonates with a birth weight (BW) between 500 and 749 grams (g), showed that 43% of infants born between 1990-1992 received DXM, compared to as many as 84% of those born between 1993-1995. The almost routine use of DXM continued until 1998, when Yeh et al published the results of a large multicenter follow-up study that demonstrated a significant increase in neurodevelopmental dysfunction in neonates treated with DXM compared with controls . More alarming publications on the long-term negative effects of DXM appeared and as a result a gradual decrease in postnatal steroid prescription was noted. The American Academy of Pediatrics stated in 2002 that, outside of clinical trials, postnatal steroid use should be reserved only for ¡°exceptional clinical circumstances¡±. However, a recent prospective evaluation of postnatal steroid administration in California from April 2002 to March 2003 showed that 19.3% of the children ¡Ü1500 g still received steroids.

Over the past years, more negative long-term neurodevelopmental sequelae following neonatal DXM treatment have been reported and very recently an MRI study at term equivalent age showed reduced brain volumes in infants, treated with a moderately low dose of DXM after 28 days of life. HC could be a suitable alternative for DXM if negative long-term side effects are less but studies on long-term outcome after postnatal HC use in preterm infants are scarce. The aim of this review is to summarize the literature on postnatal HC treatment for chronic lung disease in preterm-born infants and the available data on long-term neurodevelopmental outcome.