Systemic Steroids in Preventing Bronchopulmonary Dysplasia (BPD): Neurodevelopmental Outcome According to the Risk of BPD in the EPICE Cohort.
bronchopulmonary dysplasia
neurodevelopmental outcome
post natal steroid therapy
preterm birth
Journal
International journal of environmental research and public health
ISSN: 1660-4601
Titre abrégé: Int J Environ Res Public Health
Pays: Switzerland
ID NLM: 101238455
Informations de publication
Date de publication:
05 05 2022
05 05 2022
Historique:
received:
28
02
2022
revised:
17
04
2022
accepted:
27
04
2022
entrez:
14
5
2022
pubmed:
15
5
2022
medline:
20
5
2022
Statut:
epublish
Résumé
Postnatal steroids (PNS) have been used to prevent bronchopulmonary dysplasia (BPD) in preterm infants but have potential adverse effects on neurodevelopment. These effects might be modulated by their risk of BPD. We aimed to compare patients' neurodevelopment with PNS treatment according to their risk of BPD in a European cohort. We developed a prediction model for BPD to classify infants born between 24 + 0 and 29 + 6 weeks of gestation in three groups and compared patients' neurological outcome at two years of corrected age using the propensity score (PS) method. Of 3662 neonates included in the analysis, 901 (24.6%) were diagnosed with BPD. Our prediction model for BPD had an area under the ROC curve of 0.82. In the group with the highest risk of developing BPD, PNS were associated with an increased risk of gross motor impairment: OR of 1.95 after IPTW adjustment (95% CI 1.18 to 3.24, This study suggests that PNS might be associated with an increased risk of gross motor impairment regardless of the group risk for BPD. Further randomised controlled trials exploring the use of PNS to prevent BPD should include a risk-based evaluation of neurodevelopmental outcomes. This observation still needs to be confirmed in a randomised controlled trial.
Sections du résumé
BACKGROUND
Postnatal steroids (PNS) have been used to prevent bronchopulmonary dysplasia (BPD) in preterm infants but have potential adverse effects on neurodevelopment. These effects might be modulated by their risk of BPD. We aimed to compare patients' neurodevelopment with PNS treatment according to their risk of BPD in a European cohort.
METHODS
We developed a prediction model for BPD to classify infants born between 24 + 0 and 29 + 6 weeks of gestation in three groups and compared patients' neurological outcome at two years of corrected age using the propensity score (PS) method.
RESULTS
Of 3662 neonates included in the analysis, 901 (24.6%) were diagnosed with BPD. Our prediction model for BPD had an area under the ROC curve of 0.82. In the group with the highest risk of developing BPD, PNS were associated with an increased risk of gross motor impairment: OR of 1.95 after IPTW adjustment (95% CI 1.18 to 3.24,
CONCLUSIONS
This study suggests that PNS might be associated with an increased risk of gross motor impairment regardless of the group risk for BPD. Further randomised controlled trials exploring the use of PNS to prevent BPD should include a risk-based evaluation of neurodevelopmental outcomes. This observation still needs to be confirmed in a randomised controlled trial.
Identifiants
pubmed: 35564997
pii: ijerph19095600
doi: 10.3390/ijerph19095600
pmc: PMC9106050
pii:
doi:
Substances chimiques
Glucocorticoids
0
Steroids
0
Hydrocortisone
WI4X0X7BPJ
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Références
Neonatology. 2020;117(3):308-315
pubmed: 32454484
Cochrane Database Syst Rev. 2017 Jan 31;1:CD010941
pubmed: 28141913
Clin Perinatol. 2014 Mar;41(1):191-208
pubmed: 24524455
J Pediatr. 2014 Dec;165(6):1258-60
pubmed: 25217197
Am J Respir Crit Care Med. 2001 Jun;163(7):1723-9
pubmed: 11401896
Arch Dis Child Fetal Neonatal Ed. 2019 Jan;104(1):F30-F35
pubmed: 29321180
BMC Pediatr. 2001;1:1
pubmed: 11248841
Arch Pediatr Adolesc Med. 2007 Nov;161(11):1082-7
pubmed: 17984411
Neonatology. 2021;118(4):385-393
pubmed: 34004607
BMC Med Res Methodol. 2021 Jun 6;21(1):118
pubmed: 34092226
Dev Med Child Neurol. 2004 Jun;46(6):389-97
pubmed: 15174530
PLoS One. 2017 Jan 23;12(1):e0170234
pubmed: 28114369
Arch Dis Child. 2013 Dec;98(12):955-8
pubmed: 24030249
Arch Dis Child Fetal Neonatal Ed. 2019 Jan;104(1):F36-F45
pubmed: 29353260
Pediatrics. 2009 Apr;123(4):1124-31
pubmed: 19336371
Pediatr Res. 2005 Jan;57(1):149-56
pubmed: 15557103
Lancet. 2006 Apr 29;367(9520):1421-31
pubmed: 16650652
PLoS One. 2017 Jul 19;12(7):e0181176
pubmed: 28723921
J Perinatol. 2012 Feb;32(2):139-46
pubmed: 21546939
Acta Paediatr. 2018 Apr;107(4):554-556
pubmed: 29224252
Int J Epidemiol. 2020 Apr 1;49(2):372-386
pubmed: 32031620
Stat Med. 1996 Feb 28;15(4):361-87
pubmed: 8668867
BMC Pediatr. 2013 Dec 17;13:207
pubmed: 24345305
JAMA. 2017 Apr 4;317(13):1329-1337
pubmed: 28384828
Am J Respir Crit Care Med. 2011 Jun 15;183(12):1715-22
pubmed: 21471086
Neonatology. 2019;115(4):432-450
pubmed: 30974433
Stat Med. 2015 Dec 10;34(28):3661-79
pubmed: 26238958
Semin Perinatol. 2018 Nov;42(7):478-484
pubmed: 30401478
Cochrane Database Syst Rev. 2017 Oct 24;10:CD001146
pubmed: 29063585
Pediatrics. 2005 Mar;115(3):655-61
pubmed: 15741368
PLoS One. 2011;6(5):e20004
pubmed: 21637833