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Effect of oestradiol and progesterone replacement on bronchopulmonary dysplasia in extremely preterm infants
  1. A Trotter1,
  2. L Maier2,
  3. M Kron3,
  4. F Pohlandt1
  1. 1Section of Neonatology and Pediatric Critical Care Medicine, Children’s Hospital, University of Ulm, Ulm, Germany
  2. 2Pharmacy, University of Ulm
  3. 3Department of Biometry and Medical Documentation, University of Ulm
  1. Correspondence to:
    A Trotter
    Center for Perinatal Medicine, Children’s Hospital, University of Bonn, Sigmund-Freudstr 25, 53105 Bonn, Germany; andreas.trotter{at}


Objective: To study whether postnatal replacement of oestradiol and progesterone may help to prevent bronchopulmonary dysplasia (BPD).

Methods: This randomised placebo-controlled double-blind study enrolled 83 infants of <29 weeks gestational age and 1000 g birth weight requiring mechanical ventilation within 12 h after birth. Oestradiol (2.5 mg/kg/day) and progesterone (22.5 mg/kg/day) were given by continuous intravenous infusion of a standard lipid emulsion (15 ml/kg/day) in the replacement group (ESTRA-PRO). The placebo group received the same lipid emulsion without oestradiol or progesterone. A replacement period of at least 2 weeks but not >4 weeks was strived for and defined as “according to protocol”. The primary outcome variable was the incidence of BPD or death.

Results: The median birth weight was 670 g (min–max 400–990 g) and the gestational age 25 weeks (23.1–28.1 weeks). The incidence of BPD or death was 48% in the placebo group and 44% in the ESTRA-PRO group (p = 0.38, one-sided testing, intention to treat analysis). In infants treated according to protocol, 32% (9 of 28) in the placebo group and 14% (3 of 21) in the ESTRA-PRO group developed BPD (p = 0.08).

Conclusion: Replacement of oestradiol and progesterone was not effective for prevention of BPD or death in extremely preterm born infants. Better-powered trials are needed to evaluate this new approach.

  • ATP, according to protocol
  • BPD, bronchopulmonary dysplasia
  • ESTRA-PRO, oestradiol and progesterone replacement
  • ITT, intention to treat
  • ROP, retinopathy of prematurity
  • VEGF, vascular endothelial growth factor

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  • Published Online First 11 August 2006

  • Funding: This work was supported by the “Deutsche Forschungsgesellschaft”, DFG 395/2-1, 2-2.

  • Competing interests: None.

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