Are Steroids Safe for Premature Babies With BPD? Well, It Depends.

When a baby is born prematurely, things can get complicated pretty fast. The world is a challenging place for a child whose body isn’t quite equipped to function on its own. Often, premature babies need assistance breathing since their lungs haven’t fully developed yet. These infants use a breathing ventilator. However, in some cases the breathing ventilator brings its own set of problems. Over exposure to oxygen may lead to bronchopulmonary dysplasia (BPD). Often, the infants are given plenty of oxygen, but they don’t have the ability to take it in.

Although BPD most commonly arises in babies born ten weeks early, it can also occur in infants born on time. Infants with BPD show frightening respiratory symptoms, such as grunting, shortness of breath, and blue skin tone. Treatment must begin as soon as possible, but patients can recover. Many go on to live unaffected by BPD, yet others will continue to have chronic lung problems. To read more about BPD, click here.

Treatment often includes different forms of oxygen therapy and increased feeding through a feeding tube. Medication also prevents fluid accumulation in the lungs.

There is also research regarding systemic postnatal corticosteroids, which are a type of steroid. On one hand, corticosteroids reduce the lung inflammation that can cause BPD. There’s evidence that corticosteroids could treat, or even prevent BPD. On the other hand, corticosteroids are a powerful drug to give a newborn baby. Many wonder if adverse side effects outweigh the benefit.

Two recently released studies as this question. One measured whether systemic postnatal corticosteroids safely prevented BPD in premature babies when it was used before the infant was seven days old (early use). The other investigated the same question after the baby had reached seven days (late use). The researchers analyzed available clinical trial data regarding infants who had been given this medicine.

They found that when the steroid was given to a newborn before seven days, overall, the benefits weren’t worth it. While it reduced the time an infant needed a mechanical ventilator, the side effects were serious. They included high blood pressure, high glucose levels, risk for cerebral palsy, and stomach and bowel bleeding. There was, however, one type of steroid, called hydrocortisone which offered some hope. It seemed to produce the immediate benefits, without carrying so many nasty side effects.

The study recommended that early corticosteroid use be stopped until further research, especially a type called dexamethasone.

After seven days, the results looked a bit different. Corticosteroids still offered the same immediate advantages. It meant premature babies needed less time on a breathing ventilator, and showed lower rates of developing BPD. Researchers even found a reduced rate of death for the time period studied (28 days). However, in higher doses, the same complications discussed earlier arose. There were instances of gastrointestinal bleeding, elevated blood pressure, and reduced ability to tolerate glucose. The researchers did not find reason to believe there were longterm effects. While early use got a red light, late use received more of a yellow light when it comes to proceeding with this treatment. The study advised limited corticosteroid use in this category, specifically for infants who couldn’t be weaned off of their breathing ventilators.

November is Prematurity Awareness Month. Check out details on how you can participate here.

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