Am J Perinatol 2020; 37(14): 1425-1431
DOI: 10.1055/s-0039-1694004
Original Article

Retrospective Analysis of Short-Term Respiratory Outcomes of Three Different Steroids Used in Clinical Practice in Intubated Preterm Infants

Sfurti Nath
1   Division of Neonatology, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida
,
Anne Marie Reynolds
2   Division of Neonatal-Perinatal Medicine, Women & Children's Hospital of Buffalo, Buffalo, New York
,
Satyan Lakshminrusimha
3   Department of Pediatrics, UC Davis Children's Hospital, Sacramento, California
,
ChangXing Ma
4   Department of Biostatistics, School of Public Health, State University of New York at Buffalo, Buffalo, New York
,
Mark L. Hudak
5   Department of Pediatrics, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida
,
Rita M. Ryan
6   Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
› Author Affiliations

Abstract

Objective This study aimed to compare short-term respiratory outcomes of three steroids (dexamethasone, hydrocortisone, and methylprednisolone) to facilitate extubation by improving respiratory status in preterm infants.

Study Design This is a retrospective, single-center, cohort study of 98 intubated preterm infants ≤346/7 weeks' gestation, admitted to a 64-bed, level III neonatal intensive care unit at the Women & Children's Hospital of Buffalo, Buffalo, NY, between 2006 and 2012, who received a short course of low-dose steroids for lung disease after first week of life.

Results Study infants received dexamethasone (34%), hydrocortisone (44%), or methylprednisolone (22%) based on clinical team preference. By day 7 after initiation of steroids, extubation occurred in 59, 44, and 41%, respectively, in infants on dexamethasone, hydrocortisone, and methylprednisolone (p = 0.3). The mean respiratory severity score (RSS = fraction of inspired oxygen × mean airway pressure), a quantitative measure of respiratory status, decreased by 44% for all infants and by 59% in the dexamethasone group by day 7.

Conclusion Steroids improved short-term respiratory outcomes in all infants (RSS and extubation); by day 7, dexamethasone treatment was associated with the greatest decrease in RSS. Additional prospective, randomized trials of short-course low-dose steroids are warranted to substantiate these findings to guide clinical decision making and in evaluating differential steroid effects on long-term neurodevelopmental outcomes.

Supplementary Material



Publication History

Received: 20 December 2018

Accepted: 24 June 2019

Article published online:
05 August 2019

© 2020. Thieme. All rights reserved.

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