Neonatology Fellow Cincinnati Children's Hospital Medical Center Cincinnati, Ohio, United States
Background: Bronchopulmonary dysplasia is a disorder of lung development in premature infants that is associated with mortality and lifelong morbidity. It is now the most common indication for tracheostomy in infants, and is associated with additional risk. Most studies have focused on management strategies, such as systemic corticosteroids, used to prevent bronchopulmonary dysplasia. Very few studies have looked at the use of systemic steroids to treat infants with evolving or established lung disease. Objective: The aim of our study is to determine if a very late course of systemic steroids aids in weaning respiratory support in infants with grade 2 or 3 bronchopulmonary dysplasia and if so, whether a higher dose at this age is more effective. Design/Methods: This is a retrospective cohort study of 80 infants born at less than 33 weeks gestation, with a diagnosis of bronchopulmonary dysplasia, admitted to a Level IV NICU from January 2016 to September 2023 who received a very late course (≥34 weeks postmenstrual age) of low dose dexamethasone (0.89 mg/kg) versus moderate dose dexamethasone (3.025 mg/kg). IRB exemption has been obtained (#2022-0877). Epic chart review is complete for 74 of the infants identified. It is anticipated that data collection will be completed by November 2023 and data analysis will be completed by March 2024. Maternal and infant demographics and infant respiratory characteristics will be compared between the two cohorts, low dose dexamethasone compared to moderate dose. The primary outcome will be the percentage of infants with a step down in respiratory support (ex. invasive to non-invasive positive pressure) between the two cohorts. Additional outcomes compared between the two groups will include: growth during steroid course, overall growth during hospitalization, side effects during steroid treatment, length of stay, Brain MRI findings, and GMA results. Logistic regression analysis will be performed to evaluate for clinical factors predictive of tracheostomy despite a very late steroid course.
