Postnatal steroids and bronchopulmonar dysplasia: risks and benefits

Abstract

In the last decade there has been an important decrease in the neonatal mortality of very low birth weight premature infants. However, bronchopulmonar dysplasia (BPD) is the most frequent chronic sequelae in survivors. Inflammation plays a key role in its pathogenesis and provides the reason why postnatal steroid administration has deserved an important role, not only in research but its increasing use in NICUs. The aim of this article is to review the published evidence of the risks and benefits of steroid therapy in each postnatal age group. With early steroid use (< 72 hours after birth), for each 10 patients treated one case of BPD can be revented, but at the cost of acute complications, such as, intestinal perforation, arterial hypertension and hypertrophic cardiomyopathy. Its late use facilitates extubation and decreases oxygen requirements at 36 weeks (corrected age), but has been associated with growth failure and arterial hipertension. What is of more concern is the observed effect of systemic steroids in neurodevelopment, with a greater risk of developing motor dysfunction and cerebral palsy. It has been estimated that for 30 patients treated with steroids there will be 4 extra cases of cerebral palsy. In summary, there is growing evidence that the long term consequences of postnatal steroid administration outweigh the short term benefits. It therefore should be restricted to carefully selected cases, using lower doses and for shorter durations than currently employed.