529 - Rescue Corticosteroids for Established BPD: Comparison of Dexamethasone vs Prednisolone

Publication Number: 3510.529

Rawan Al-Rawi, Boston Children's Hospital, Boston, MA, United States; Kristen T. Leeman, Boston Children's Hospital, Winchester, MA, United States; Jonathan C. Levin, Harvard Medical School, Boston, MA, United States

Background: Rescue postnatal corticosteroids are commonly used for infants with established or evolving BPD, though sparse comparative data on optimal agent exists.

Objective: To compare short-term respiratory response and safety of DEXA (typically DART 10-day protocol dosing) versus PRED (prednisolone or methylprednisolone 14-day taper) used as therapy for lung disease beyond 28 days of life.

Design/Methods: We are conducting an ongoing retrospective single-center analysis of preterm infants < 32 weeks treated with systemic steroids for lung disease, defined as dependence on invasive or non-invasive ventilation, at >28 days of life. Baseline characteristics, timing, respiratory support, growth, and adverse events were abstracted. Primary outcomes were FiO₂ reduction by 20%, mRSS decrease (by ≥1 or 20%, whichever was smaller), extubation, and mode weaning at end of course or within 10 days; as well as growth parameters during the steroid course and 30 days later. Comparisons used two-sample tests as appropriate and mixed effect on linear regression.

Results: Forty-three steroid courses in 30 infants were included in this initial analysis. There were 10 DEXA courses across 9 patients and 33 PRED courses across 26 patients; 5 had both a DEXA and PRED course. The mean DEXA duration was 10.2 days, and PRED duration was 13.4 days. The DEXA and PRED groups were similar at baseline (Table 1), including GA, BW, SGA, and respiratory severity at start of steroid course. DEXA was used at earlier PMA than PRED (median 35.2 vs 39.0 weeks, p=0.06), although not significant. Short-term respiratory outcomes were similar for those who received DEXA vs PRED (Table 2, Figure 1a-b). There was a trend towards a greater decrease in weight z-score at 30d in the DEXA group compared to the PRED group (-0.56 vs 0.15, p=0.085) and smaller increase in head circumference z-score at 30d in the DEXA group (0.12 vs 0.24, p=0.082) (Figure 1c-e). In mixed effect linear regression, steroid type had no effect on FiO2 or mRSS trajectory at the end and 10 days post steroid course. DEXA was associated with a greater decrease in weight z-score at the end (effect -0.25, 95% CI -0.52 to 0.01) and 30 days post steroid course (effect -0.40, 95% CI -0.70 to -0.11).

Conclusion(s): In this cohort of steroid courses used for treatment of evolving or established lung disease, patient characteristics and respiratory outcomes were similar among DEXA and PRED groups. Weight trajectory was more negatively impacted in the DEXA group. Additional retrospective data and prospective studies are needed to clarify comparative effectiveness and safety.

Table 1. Baseline Characteristics
P-values calculated by Wilcoxon-rank sum for continuous variables and chi-squared for categorical variables.

Abbreviation:
n: number
IQR: interquartile range
SD: standard deviation
mRSS: modified respiratory severity score
BW: birth weight
PMA: postmenstrual age
DOL: day of life
SGA: small for gestational age
PDA: patent ductus arteriosus
UTI: urinary tract infection
NEC: necrotizing enterocolitis
FiO2: fraction of inspired oxygen
HFJV: high frequency jet ventilation
HFOV: high frequency oscillatory ventilation
CMV: conventional mechanical ventilation
BiPAP: bilevel positive airway pressure
NIPPV: noninvasive positive pressure ventilation
CPAP: continuous positive airway pressure
DEXA: dexamethasone
PRED: prednisolone

Table 2. Respiratory and Growth Outcomes
P-values calculated by Wilcoxon-rank sum for continuous variables and chi-squared for categorical variables.

Abbreviation:
n: number
IQR: interquartile range
Decr: decrease
mRSS: modified respiratory severity score
HC: head circumference
BPD: bronchopulmonary dysplasia
UTI: urinary tract infection
ROP: retinopathy of prematurity
FiO2: fraction of inspired oxygen
DEXA: dexamethasone
PRED: prednisolone

Figure 1. Respiratory and Growth Responses to Late Rescue Corticosteroids (DEXA vs PRED)
Trends in modified Respiratory Severity Score (mRSS) [A], FiO₂ [B], and weight [C], length [D], and head circumference [E] z-scores from steroid initiation to 10 days post-therapy, stratified by steroid type (DEXA vs PRED). Shaded areas represent 95% confidence intervals.