Published online February 1, 2008
PEDIATRICS Vol. 121 No. 2 February 2008, pp. e344-e349 (doi:10.1542/10.1542/peds.2006-3668)

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ARTICLE

Effect of a Short Course of Prednisolone in Infants With Oxygen-Dependent Bronchopulmonary Dysplasia

Anita Bhandari, MD^a, Craig M. Schramm, MD^a, Claudia Kimble, APRN^b, Mariann Pappagallo, MD^b and Naveed Hussain, MD^b

^a Division of Pediatric Pulmonology, Connecticut Children's Medical Center, Hartford, Connecticut
^b Division of Neonatology, Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut

OBJECTIVE. The purpose of this work was to determine whether oral prednisolone is effective in weaning infants with bronchopulmonary dysplasia, after 36 weeks' postmenstrual age, off supplemental oxygen and to identify factors associated with successful weaning.

METHODS. Data were abstracted from a standardized prospectively collected database at the John Dempsey Hospital NICU. Logistic regression and receiver operating curve analyses were used.

RESULTS. Of 385 infants, 131 (34%) received oral prednisolone and 254 (66%) did not. There was no significant difference in race, gender, birth weight, or gestational age between the groups receiving and not receiving oral prednisolone. Infants in the oral prednisolone group were more likely to have received previous dexamethasone therapy, had longer duration of mechanical ventilation, had longer length of hospital stay, and were more likely to be discharged from the hospital on oxygen. Of those in the oral prednisolone group, 63% responded to treatment. Pulmonary acuity score and PCO₂ were the only parameters that remained significant on multiple logistic regression analyses. The oral prednisolone-responsive group had a lower pulmonary acuity score compared with the oral prednisolone-nonresponsive group. A pulmonary acuity score value of 0.5 had a sensitivity of 20% and specificity of 97.4%, with positive and negative predictive values of 94.1% and 42.1%, respectively. Capillary PCO₂ values were significantly lower in the oral prednisolone-responsive group compared with the oral prednisolone-nonresponsive group. In predicting a successful response to oral prednisolone, a capillary PCO₂ value of <48.5 mmHg had a sensitivity of 50% and specificity of 89.7%, with positive and negative predictive values of 89.1% and 51.8%, respectively.

CONCLUSIONS. Oral prednisolone therapy is effective in weaning off supplemental oxygen in a postterm infant with oxygen-dependent bronchopulmonary dysplasia who has a pulmonary acuity score of <0.5 and PCO₂ of <48.5 mmHg. In addition, if a single course of prednisolone fails, there is no clear benefit of using multiple courses.

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Key Words: BPD • prednisolone • oxygen therapy • outcome

Abbreviations: BPD—bronchopulmonary dysplasia • PMA—postmenstrual age • OP—oral prednisolone • No-OP—subjects who did not receive oral prednisolone • OP-R—subjects who responded to oral prednisolone therapy • OP-NR—subjects who did not respond to oral prednisolone therapy • PAS—pulmonary acuity score • FIO₂—fraction of inspired oxygen • ROC—receiver operating curve • CI—confidence interval

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Accepted Jul 5, 2007.

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