BMJ Open (Nov 2022)

Postnatal corticosteroid use for prevention or treatment of bronchopulmonary dysplasia in England and Wales 2012–2019: a retrospective population cohort study

  • Neena Modi,
  • ,
  • Chris Gale,
  • Iyad Al-Muzaffar,
  • Jonathan Cusack,
  • Victoria Nesbitt,
  • Sanjay Salgia,
  • Matthew Babirecki,
  • Aashish Gupta,
  • L M Wong,
  • Anita Mittal,
  • Ahmed Hassan,
  • Karin Schwarz,
  • Graham Whincup,
  • Abdul Hasib,
  • Mehdi Garbash,
  • David Gibson,
  • Pauline Adiotomre,
  • Abby Deketelaere,
  • Stanley Zengeya,
  • Cath Seagrave,
  • Hilary Dixon,
  • Narendra Aladangady,
  • Hassan Gaili,
  • Matthew James,
  • M Lal,
  • Lawrence Miall,
  • Venkatesh Kairamkonda,
  • J Kefas,
  • Jennifer Birch,
  • Gail Whitehead,
  • I Misra,
  • Subodh Gupta,
  • Steven Wardle,
  • Eleri Adams,
  • Minesh Khashu,
  • Charlotte Groves,
  • Christos Zipitis,
  • Peter De Halpert,
  • Joanne Fedee,
  • Stephen Jones,
  • Kirsten Mack,
  • Charlotte Huddy,
  • Salim Yasin,
  • Ngozi Edi-osagie,
  • Carrie Heal,
  • Jacqeline Birch,
  • Hari Kumar,
  • Chris Rawlingson,
  • Delyth Webb,
  • Sankara Narayanan,
  • Elizabeth Eyre,
  • Caroline Sullivan,
  • Wynne Leith,
  • Vimal Vasu,
  • Katia Vamvakiti,
  • Megan Eaton,
  • Ambalika Das,
  • Katharine Mcdevitt,
  • Anna Gregory,
  • Shu-Ling Chuang,
  • Sabita Uthaya,
  • Cheryl Battersby,
  • Imran Ahmed,
  • Chris Warren,
  • Tristan Bate,
  • Mark Johnson,
  • Sunil Reddy,
  • Rashmi Gandhi,
  • Nitin Goel,
  • Richard Hearn,
  • Cheentan Singh,
  • Faith Emery,
  • Vineet Gupta,
  • Yee Aung,
  • Vennila Ponnusamy,
  • Pinki Surana,
  • Anand Kamalanathan,
  • Kavi Aucharaz,
  • Lindsay Halpern,
  • Matt Nash,
  • Alex Allwood,
  • Nigel Brooke,
  • Jennifer Holman,
  • Geraint Lee,
  • Sobia Balal,
  • Poornima Pandey,
  • Ravindra Bhat,
  • Simon Rhodes,
  • Savi Sivashankar,
  • Michael Grosdenier,
  • Ajay Reddy,
  • Prakash Thiagarajan,
  • Chinnappa Reddy,
  • Lidia Tyszcuzk,
  • Glynis Rewitzky,
  • Bushra Abdul-Malik,
  • Dominic Muogbo,
  • Angela D'Amore,
  • John McIntyre,
  • Lucinda Winckworth,
  • Jim Baird,
  • Akinsola Ogundiya,
  • Pamela Cairns,
  • Porus Bastani,
  • Marice Theron,
  • Siba Paul,
  • Giles Kendall,
  • Puneet Nath,
  • Ros Garr,
  • Sundeep Sandhu,
  • Michael Cronin,
  • Alison Bedford Russell,
  • Ruchika Gupta,
  • Archana Mishra,
  • Oluseun Tayo,
  • Priya Muthukumar,
  • Brendan Harrington,
  • Victoria Sharp,
  • Nicola Johnson,
  • Sam Wallis,
  • Prashanth Bhat,
  • Lee Abbott,
  • Raju Narasimhan,
  • Kate Creese,
  • Divyen Shah,
  • Clare Cane,
  • Ghada Ramadan,
  • Sijia Yao,
  • Alistair Ewing,
  • Penelope Young,
  • Ramona Onita,
  • Joanne Dangerfield,
  • Jocelyn Morris,
  • Toria Klutse,
  • Sonia Spathis,
  • Sathish Krishnan,
  • Samar Sen,
  • Jez Jones,
  • Geedi Farah,
  • Prem Pitchaikani,
  • Jonathan Filkin,
  • Ashok Karupaiah,
  • Richard Heaver,
  • Mohammad Alam,
  • Tiziana Fragapane,
  • Jess Reynolds,
  • Khadija Ben-Sasi,
  • Patricia Cowley,
  • Shilpa Ramesh,
  • Julia Croft,
  • Soma Sengupta,
  • Nagendra Venkata,
  • Anitha Vayalakkad,
  • Ben Obi,
  • Anjali Petkar,
  • Arun Ramachandran,
  • Se-Yeon Park,
  • Sue Bird,
  • Jageer Mohammed,
  • Sanjay Jaisal

DOI
https://doi.org/10.1136/bmjopen-2022-063835
Journal volume & issue
Vol. 12, no. 11

Abstract

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Objective Describe the population of babies who do and do not receive postnatal corticosteroids for prevention or treatment of bronchopulmonary dysplasia (BPD).Design Retrospective cohort study using data held in the National Neonatal Research Database.Setting National Health Service neonatal units in England and Wales.Patients Babies born less than 32 weeks gestation and admitted to neonatal units from 1 January 2012 to 31 December 2019.Main outcomes Proportion of babies given postnatal corticosteroid; type of corticosteroid; age at initiation and duration, trends over time.Secondary outcomes Survival to discharge, treatment for retinopathy of prematurity, BPD, brain injury, severe necrotising enterocolitis, gastrointestinal perforation.Results 8% (4713/62019) of babies born <32 weeks and 26% (3525/13527) born <27 weeks received postnatal corticosteroids for BPD. Dexamethasone was predominantly used 5.3% (3309/62019), followed by late hydrocortisone 1.5%, inhaled budesonide 1.5%. prednisolone 0.8%, early hydrocortisone 0.3% and methylprednisolone 0.05%. Dexamethasone use increased over time (2012: 4.5 vs 2019: 5.8%, p=0.04). Median postnatal age of initiation of corticosteroid course was around 3 weeks for late hydrocortisone, 4 weeks for dexamethasone, 6 weeks for inhaled budesonide, 12 weeks for prednisolone and 16 weeks for methylprednisolone. Babies who received postnatal corticosteroids were born more prematurely, had a higher incidence of comorbidities and a longer length of stay.Conclusions In England and Wales, around 1 in 12 babies born less than 32 weeks and 1 in 4 born less than 27 weeks receive postnatal corticosteroids to prevent or treat BPD. Given the lack of convincing evidence of efficacy, challenges of recruiting to and length of time taken to conduct randomised controlled trial, our data highlight the need to monitor long-term outcomes in children who received neonatal postnatal corticosteroids.