Time-related Changes in Steroid Use and Bronchopulmonary Dysplasia in Preterm Infants

Objective: To assess dexamethasone (DEX) and hydrocortisone (HC) use in premature infants over time and the association of steroid use with the incidence of bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age.

Methods: We analyzed data from the Pediatrix database for neonates of 23 to 32 weeks' gestation managed during 1997-2006 (N = 77520). We compared the use of DEX, HC and BPD (defined by oxygen use at 36 weeks' postmenstrual age) according to year and estimated gestational age. Mantel-Haenszel chi(2) was used to compare the trends in steroid use and BPD rates according to year.

Results: There were no differences by year in the proportion of births at each gestation or in early or late neonatal death. DEX use decreased from a peak of 25.0% in 1998 to 6.8% in 2006, but HC use increased from 1.1% in 1997 to a peak of 6.5% in 2006. The median age at initiation of DEX use increased >2 weeks from 1997 to 2006. BPD rates increased from 19% in 1997 to 25% by 2006. Rates for severe BPD (defined by positive pressure support) also increased significantly over time. Between 23 and 28 weeks, there was a significant increase in BPD rates associated with the decrease in DEX over time.

Conclusions: Steroid use and preference have changed significantly over the past decade. Decreased use of DEX was associated with increased rates of BPD, any or severe, among very preterm infants. Well-designed, randomized, noncrossover trials with long-term outcome analysis of high-risk infants are needed.