Affiliation:
1. Department of Medicine and Surgery, Neonatology Unit, AOUP, University of Parma, Parma, Italy
2. Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
3. Department of Woman and Child, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy
Abstract
Abstract:
Despite using antenatal steroids, surfactants and protective ventilation, bronchopulmo-nary dysplasia (BPD) affects 10-89% of preterm infants. Since lung inflammation is central to the BPD pathogenesis, postnatal systemic corticosteroids could reduce the risk of BPD onset in preterm infants, but short and long-term adverse consequences have been underlined in literature after their use (i.e., hyperglycaemia, hypertension, hypertrophic cardiomyopathy, growth failure, gastrointesti-nal bleeding, cerebral palsy). Alternative therapeutic strategies such as postponing corticosteroid administration, lowering the cumulative dose, giving pulse rather than continuous doses, or individ-ualizing the dose according to the respiratory condition of the infant have been proposed to avoid their adverse effects. Dexamethasone remains the first-line drug for newborns with severe pulmo-nary disease beyond the second to the third week of life. Hydrocortisone administration in very pre-term infants does not appear to be associated with neurotoxic effects, even if its efficacy in prevent-ing and treating BPD has yet been clearly demonstrated. Alternative methods of corticosteroid ad-ministration seem promising. A positive effect on BPD prevention occurs when budesonide is nebu-lized and intratracheally instilled with a surfactant, but more data are required to establish safety and efficacy in preterm newborns. Additional studies are still needed before the chronic lung dis-ease issue, and its related challenges can be solved.
Publisher
Bentham Science Publishers Ltd.
Subject
Pediatrics, Perinatology and Child Health