PEDIATRICS Vol. 117 No. 3 March 2006, pp. 704-713 (doi:10.1542/peds.2005-0796)
Prospective Evaluation of Postnatal Steroid Administration: A 1-Year Experience From the California Perinatal Quality Care Collaborative
a Department of Neonatology, University of California San Diego Medical Center, San Diego, California
b Department of Neonatology, Childrens Hospital and Research Center, Oakland, California
c Department of Neonatal and Developmental Pediatrics, California Perinatal Quality Care Collaborative, Stanford University, Stanford, California
d Perinatal Quality Improvement Panel, California Perinatal Quality Care Collaborative, Southern California Permanente Medical Group, Los Angeles, California
OBJECTIVE. Postnatal steroids (PNSs) are used frequently to prevent or treat chronic lung disease (CLD) in the very low birth weight (VLBW) infant, and their use continues despite concerns regarding an increased incidence of longer-term neurodevelopmental abnormalities in such infants. More recently, there has been a suggestion that corticosteroids may be a useful alternative therapy for hypotension in VLBW infants, but there have been no prospective reports of such use for a current cohort of VLBW infants.
METHODS. The California Perinatal Quality Care Collaborative (CPQCC) requested members to supplement their routine Vermont Oxford Network data collection with additional information on any VLBW infant treated during their hospital course with PNS, for any indication. The indication, actual agent used, total initial daily dose, age at treatment, type of respiratory support, mean airway pressure, fraction of inspired oxygen, and duration of first dosing were recorded.
RESULTS. From April 2002 to March 2003 in California, 22 of the 62 CPQCC hospitals reported supplemental data, if applicable, from a cohort of 1401 VLBW infants (expanded data group [EDG]), representing 33.2% of the VLBW infants registered with the CPQCC during the 12-month period. PNSs for CLD were administered to 8.2% of all VLBW infants in 2003, 8.6% of infants in the 42 hospitals that did not submit supplemental data (routine data-set group, compared with 7.6% in EDG hospitals). Of the 1401 VLBW infants in the EDG, 19.3% received PNSs; 3.6% received PNSs for only CLD, 11.8% for only non-CLD indications, and 4.0% for both indications. At all birth weight categories, non-CLD use was significantly greater than CLD use. The most common non-CLD indication was hypotension, followed by extubation stridor, for which 36 (16.3%) infants were treated. For hypotension, medications used were hydrocortisone followed by dexamethasone. Infants treated with PNSs exclusively for hypotension had a significantly higher incidence of intraventricular hemorrhage, periventricular leukomalacia, and death when compared with infants treated only for CLD or those who did not receive PNSs.
CONCLUSIONS. The common early use of hydrocortisone for hypotension and the high morbidity and mortality in children receiving such treatment has not been recognized previously and prospective trials evaluating the short- and long-term risk/benefit of such treatment are urgently required.
Key Words: chronic lung disease • hydrocortisone • hypotension • preterm infant
Abbreviations: PNS—postnatal steroid • RDS—respiratory distress syndrome • IVH—intraventricular hemorrhage • CLD—chronic lung disease • ELBW—extremely low birth weight • CPQCC—California Perinatal Quality Care Collaborative • VON—Vermont Oxford Network • VLBW—very low birth weight • IQR—interquartile range • BPD—bronchopulmonary dysplasia • FIO2—fraction of inspired oxygen • EDG—expanded data group • RDG—routine data group • PVL—periventricular leukomalacia
Accepted Jul 13, 2005.
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