AAP Policy Statement: Postnatal Corticosteroids for Chronic Lung Disease Following Preterm Birth

In a policy statement, the American Academy of Pediatrics provides “guidance on the use of postnatal corticosteroids to manage or prevent chronic lung disease following preterm birth (formerly referred to as bronchopulmonary dysplasia).” Prospective randomized trials published since 2010 were used to update the recommendations and recommendations as follows:

Conclusions

1. Postnatal corticosteroids (PCSs), either to prevent or treat early chronic lung disease (CLD), may increase the rate of survival without severe CLD but carry significant short- and long-term risks.
2. Early (≤7 days) low-dose hydrocortisone may prevent CLD or death in infants weighing less than 1000 g exposed to chorioamnionitis. High-dose dexamethasone (≥0.5 mg/kg per day) is not recommended.
3. Late (>7 and <28 days of age) low-dose dexamethasone may improve outcomes for preterm infants who remain on significant respiratory support but without evidence of severe CLD.
4. Inhaled corticosteroids do not appear to offer any advantage over systemic corticosteroids and may be associated with increased mortality.
5. Corticosteroids may be more effective when delivered directly into the lung with surfactant as a vehicle, but data on long-term outcomes are lacking.
6. Data from randomized controlled trials are population based and may not apply to individual patients.
7. More data regarding long-term, school-aged outcomes are needed to guide the use of PCSs to prevent or treat CLD in preterm infants.

Recommendations

1. Routine use of PCSs cannot be recommended.
2. The decision to use PCSs to prevent or treat CLD should be individualized and made together with the parents, and the discussions should be documented in the patient’s medical record.
3. If a decision is made to administer a PCS, a low dose provided for a short, predefined duration (eg, extubation) is recommended. If the infant does not show a clinical response to the PCS within 72 hours of initiation, continued treatment is not recommended.
4. High-dose PCSs are not recommended to prevent or treat CLD in preterm infants.
5. Indomethacin should not be used concurrently with PCSs.