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Less postnatal steroids, more bronchopulmonary dysplasia: a population-based study in very low birthweight infants
  1. E S Shinwell1,
  2. L Lerner-Geva2,
  3. A Lusky2,
  4. B Reichman2,
  5. in collaboration with the Israel Neonatal Network
  1. 1Department of Neonatology, Kaplan Medical Center, Rehovot, Hadassah Medical School, Hebrew University, Jerusalem, Israel
  2. 2Women and Children’s Health Research Unit, Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel
  1. Correspondence to:
    E S Shinwell
    Department of Neonatology, Kaplan Medical Center, Rehovot 76100, Israel;eric_s{at}clalit.org.il

Abstract

Objective: To study the association between reduced use of postnatal steroids for bronchopulmonary dysplasia (BPD) in very low birthweight (VLBW) infants and oxygen (O2)-dependency at 28 days of age and at 36 weeks postmenstrual age.

Design: Large national database study.

Setting: The Israel National VLBW Neonatal Database.

Patients: The sample included infants born between 1997 and 2004, of gestational age 24–32 weeks, who required mechanical ventilation or O2 therapy. Four time periods were compared: 1997–8 (era 1, peak use), 1999–2000 (era 2, intermediate), 2001–2 (era 3, expected reduction) and 2003–4 (era 4, lowest). The outcome variable “oxygen dependency” was based on clinical criteria. Multivariate regression models were used to account for confounding variables.

Results: Steroid use fell significantly from 23.5% in 1997–8 to 11% in 2003–4 (p<0.005). After adjustment for relevant confounding variables, the odds ratio for O2 therapy at 28 days in era 4 versus era 1 was 1.75, 95% confidence interval (CI) 1.47 to 2.09 and 1.41, 95% CI 1.15 to 1.73 at 36 weeks postmenstrual age. The mean duration of O2 therapy increased from 25.3 days (95% CI 23.3 to 26.3) in era 1, to 28.0 days (95% CI 26.6 to 29.4) in era 4. Survival increased from 78.5% in era 1 to 81.6% in era 4 (p<0.005).

Conclusions: The use of steroids has fallen considerably since the awareness of the adverse effects of this treatment. This change has been temporally associated with increased O2 dependency at 28 days of age and at 36 weeks postmenstrual age. The prolongation of O2 therapy was modest in degree.

  • BPD, bronchopulmonary dysplasia
  • CLD, chronic lung disease
  • PMA, postmenstrual age
  • VLBW, very low birthweight

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Footnotes

  • Published Online First 13 July 2006

  • Funding: The Israel National Very Low Birth Weight Infant Database is partially funded by the Israel Center for Disease Control and the Ministry of Health.

  • Competing interests: None declared.

  • The Israel Neonatal Network participating centres are: Assaf Harofeh Medical Center, Rishon Le Zion; Barzilay Medical Center, Ashkelon; Bikur Holim Hospital, Jerusalem; Bnei Zion Medical Center, Haifa; Carmel Medical Center, Haifa; English (Scottish) Hospital, Nazareth; French Hospital, Nazareth; Hadassah University Hospital, Ein-Kerem, Jerusalem; Hadassah University Hospital, Har Hatzofim, Jerusalem; Haemek Medical Center, Afula; Hillel Yaffe Medical Center, Hadera; Italian Hospital, Nazareth; Kaplan Medical Center, Rehovot; Laniado Hospital, Netanya; Mayanei Hayeshua Hospital, Bnei Brak; Meir Medical Center, Kfar Saba; Misgav Ladach Hospital, Jerusalem; Nahariya Hospital, Nahariya; Poria Hospital, Tiberias; Rambam Medical Center, Haifa; Rivka Ziv Hospital, Tsfat; Schneider Children’s Medical Center of Israel and Rabin Medical Center (Beilinson Campus), Petach Tikva; Shaarei Zedek Hospital, Jerusalem; Soroka Medical Center, Beersheva; Sourasky Medical Center, Tel Aviv; Wolfson Medical Center, Holon; Yoseftal Hospital, Eilat. Coordinating Center: Women’s and Children’s Health Research Institute, Tel Hashomer, Israel.

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