Postnatal corticosteroids for bronchopulmonary dysplasia

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The occurrence and slow resolution of bronchopulmonary dysplasia (BPD) is one of the most frustrating management problems in neonatology. As with most intractable diseases, corticosteroid treatments are tried. In the case of BPD, initial results were positive but long-term follow-up suggested that postnatal corticosteroids increased brain injury and inhibited brain growth. These adverse effects resulted in recommendations by the American Academy of Pediatrics and the Canadian Pediatric Association that postnatal corticosteroids not be used to try to prevent or treat BPD. This recommendation did decrease the excessive use of these potent agents, but studies of their use continue because corticosteroid treatments do improve short-term respiratory outcomes. A recent report by Doyle et al (Pediatrics 2005:115, 655-661) argues that corticosteroids benefit infants at high risk of severe BPD.

In this issue of The Journal, Rademaker et al reports that hydrocortisone treatments for BPD did not adversely affect the brain MRI or neurodevelopmental outcomes at school age. Nixon et al further report that postnatal dexamethasone treatments may improve respiratory outcomes at school age. An editorial by Watterberg puts this contentious area of treatment into perspective and points out the multiple questions that remain.