Alaina Linafelter1, Alain Cuna2, Cynthia Liu3, Anastasia Quigley4, William E Truog5, Venkatesh Sampath6, Alexandra Oschman7. 1. Department of Pharmacy, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA. Electronic address: aelinafelter@cmh.edu. 2. School of Medicine, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA; Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA; Center for Infant Pulmonary Disorders, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA. Electronic address: accuna@cmh.edu. 3. School of Medicine, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA. Electronic address: clpt5@mail.umkc.edu. 4. School of Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA. Electronic address: a163q615@kumc.edu. 5. School of Medicine, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA; Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA; Center for Infant Pulmonary Disorders, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA. Electronic address: wtruog@cmh.edu. 6. School of Medicine, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA; Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA. Electronic address: vsampath@cmh.edu. 7. Department of Pharmacy, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA. Electronic address: aoschman@cmh.edu.
Abstract
BACKGROUND: There are few published data on the efficacy and safety of prednisolone in preterm infants with bronchopulmonary dysplasia (BPD). AIMS: To describe the use of chronic prednisolone therapy in a population of infants with severe BPD, examine potential benefits on respiratory status, and document potential effects on growth. STUDY DESIGN: Single-center retrospective cohort study. SUBJECTS: Preterm infants who had received ≥30 days of prednisolone for the treatment of severe BPD. OUTCOME MEASURES: Weekly changes in Pulmonary Severity Score (PSS), as well as weekly changes in weight, length, and head circumference during prednisolone therapy. RESULTS: Forty-three infants (mean birth weight 729 g; mean gestational age 26 weeks) were identified. The average age at start of prednisolone treatment was 42.5 ± 5.9 weeks; while the median duration and median cumulative dose of prednisolone therapy were 67 (IQR 57-107) days and 61.3 (IQR 39.9-93.3) mg/kg, respectively. PSS decreased after 1 week of prednisolone therapy (mean difference, 0.19; 95% Cl, 0.01 to 0.37; p = 0.03). No further reduction in PSS was noted despite continued treatment. Length z-scores decreased after 4 weeks of continued treatment (mean difference 0.6; 95% CI 0.01 to 1.1; P = 0.04), while weight and head circumference did not change. CONCLUSIONS: In one of the first reports on prednisolone therapy for severe BPD, we describe that long-term prednisolone is associated with modest short-term improvement in PSS, but impairs linear growth. Our results suggest a risk-benefit profile of prednisolone that does not favor long-term use in infants with severe BPD.
BACKGROUND: There are few published data on the efficacy and safety of prednisolone in preterm infants with bronchopulmonary dysplasia (BPD). AIMS: To describe the use of chronic prednisolone therapy in a population of infants with severe BPD, examine potential benefits on respiratory status, and document potential effects on growth. STUDY DESIGN: Single-center retrospective cohort study. SUBJECTS: Preterm infants who had received ≥30 days of prednisolone for the treatment of severe BPD. OUTCOME MEASURES: Weekly changes in Pulmonary Severity Score (PSS), as well as weekly changes in weight, length, and head circumference during prednisolone therapy. RESULTS: Forty-three infants (mean birth weight 729 g; mean gestational age 26 weeks) were identified. The average age at start of prednisolone treatment was 42.5 ± 5.9 weeks; while the median duration and median cumulative dose of prednisolone therapy were 67 (IQR 57-107) days and 61.3 (IQR 39.9-93.3) mg/kg, respectively. PSS decreased after 1 week of prednisolone therapy (mean difference, 0.19; 95% Cl, 0.01 to 0.37; p = 0.03). No further reduction in PSS was noted despite continued treatment. Length z-scores decreased after 4 weeks of continued treatment (mean difference 0.6; 95% CI 0.01 to 1.1; P = 0.04), while weight and head circumference did not change. CONCLUSIONS: In one of the first reports on prednisolone therapy for severe BPD, we describe that long-term prednisolone is associated with modest short-term improvement in PSS, but impairs linear growth. Our results suggest a risk-benefit profile of prednisolone that does not favor long-term use in infants with severe BPD.
Authors: Zeyar T Htun; Elizabeth V Schulz; Riddhi K Desai; Jaime L Marasch; Christopher C McPherson; Lucy D Mastrandrea; Alan H Jobe; Rita M Ryan Journal: J Perinatol Date: 2021-05-19 Impact factor: 2.521
Authors: Mihai Puia-Dumitrescu; Thomas R Wood; Bryan A Comstock; Janessa B Law; Kendell German; Krystle M Perez; Semsa Gogcu; Dennis E Mayock; Patrick J Heagerty; Sandra E Juul Journal: JAMA Netw Open Date: 2022-03-01