Investigation of the effects of postnatal systemic corticosteroid therapy on early neonatal morbidities in preterms with broncopulmonary dysplasia

Introduction: Bronchopulmonary dysplasia is one of the most important causes of chronic pulmonary morbidity and mortality associated with prematurity. Systemic corticosteroids have been used to prevent bronchopulmonary dysplasia in premature infants due to their anti-inflammatory properties. Reducing pulmonary inflammation with postnatal systemic corticosteroids in premature infants reduces the risk of bronchopulmonary dysplasia but may be associated with an increased risk of adverse neurodevelopmental prognosis. Objective: The aim of this study was to investigate the effects of postnatal systemic corticosteroid therapy on early neonatal morbidities in preterm patients with a diagnosis of Bronchopulmonary Dysplasia. Materials and Methods: In this study, patients hospitalized with the diagnosis of bronchopulmonary dysplasia in Ankara Bilkent City Hospital Neonatal Intensive Care Unit between 01.09.2019 and 30.9.2022 were included. The study was planned retrospectively. The study group consisted of patients who received or did not receive systemic corticosteroid therapy for bronchopulmonary dysplasia. When classifying the patients, the patients who did not receive postnatal systemic corticosteroid treatment were classified as "Group 1" and the patients receiving corticosteroid treatment as "Group 2". Patients receiving a single cure postnatal systemic corticosteroid therapy were classified as "Group 2a" and patients receiving repeated doses were classified as "Group 2b". Analysis of the data obtained from the study was performed with IBM SPSS 25.0 (Statistical Package for Social Sciences). Results: The study was conducted with a total of 162 patients. It was observed that 108 (66%) of the patients did not receive postnatal systemic corticosteroid treatment. It was determined that 37 (23%) received a single course and 17 (11%) received postnatal systemic corticosteroid treatment at repeated doses. No statistically significant difference was found between Group 1 and Group 2 in terms of antenatal and maternal descriptive characteristics. In terms of neonatal descriptive characteristics, it was seen that group 2 had a lower gestational week (group 2: 26.8±1.9, group 1: 28.4±1.9). They were born with a lower birth weight (group 2: 915±274 grams, group 1: 1223±351 grams) and had lower 1st and 5th min apgar scores (group 1: 4.67±1.7 and 6.59± 1.5; group 2: 3.93±1.5 and 6.09±1.4). The mean Fio2 requirement of group 2 in the first 28 days was found to be statistically significantly higher than group 1 (Fio2: 36.6%- 27.3%, p<0.001). It was observed that Group 2 had longer invasive ventilation time, longer total oxygen support time, higher ROP frequency and more frequent sepsis history. There was no difference in terms of NEC, PDA, and IVH frequencies. It was determined that group 2 had a longer hospitalization period (group 2: 119±40 days, group 1: 74±33 days), and the oxygen requirement at discharge was more frequent (42%-10%). Of the 54 patients who received postnatal systemic corticosteroid treatment, 38 (70%) received dexamethasone, 10 (18%) hydrocortisone, and 6 (11%) both treatments at different times. The day of first systemic corticosteroid treatment was determined as the mean postnatal 44th day. The mean anti-inflammatory equivalent dose of corticosteroid therapy was 1.68 mg/kg in patients who received a single course of corticosteroid therapy, while the average of those who received repeated doses of corticosteroid therapy was 2.9 mg/kg. When Group 2a and Group 2b were compared, it was seen that they had similar antenatal, maternal and neonatal descriptive features. Neonatal morbidities in patients who received repeated doses of systemic corticosteroid treatment were similar to those who received a single course. Conclusions: We think that postnatal systemic corticosteroid therapy improves respiratory morbidities and BPD in patients with bronchopulmonary dysplasia. At the same time, we can say that postnatal systemic corticosteroid treatment has positive effects on respiratory morbidities and BPD in patients given recurrent doses of corticosteroids. Our patients who received repeated doses of postnatal systemic corticosteroid treatment received an average of 2.6 times more doses of corticosteroids than our patients who received a single course of corticosteroid treatment. Considering the acute side effects and long-term neurodevelopmental side effects of systemic corticosteroid therapy, postnatal systemic corticosteroid therapy is a decision that should be carefully considered. Keywords: Bronchopulmonary Dysplasia, Corticosteroid, Chronic Lung Disease, Preterm, Early Neonatal Morbidities