524 - Impact of the addition of the STOP-BPD Protocol to our lung management bundle on Respiratory Outcomes in Extremely Preterm Infants

Publication Number: 3505.524

Laure Salmon, Universite de Montreal Faculty of Medicine, Montréal, PQ, Canada; Zeynep Uludag, Universite de Montreal Faculty of Medicine, Montreal, PQ, Canada; Noémie Chabot, CHU Sainte-Justine research center, Montréal, PQ, Canada; Ojasvi Gupta, Universite de Montreal Faculty of Medicine, Montreal, PQ, Canada; Andrea Sarah Lo, Universite de Montreal Faculty of Medicine, Montréal, PQ, Canada; Constance Bouthillier, Université de Montréal, Montreal, PQ, Canada; Josianne Malo, CHU Sainte-Justine, Montreal, PQ, Canada; Guillaume Ethier, CHU Sainte-Justine, Montreal, PQ, Canada; Gregory Lodygensky, Universite de Montreal Faculty of Medicine, Montreal, PQ, Canada

Background: Postnatal corticosteroids are used in extremely preterm infants to modulate pulmonary inflammation, facilitate extubation, and prevent bronchopulmonary dysplasia (BPD). However, concerns regarding potential neurodevelopmental and adverse systemic effects have limited their routine use, especially with dexamethasone, which known for its toxicity. The SToP-BPD clinical trial (Onland, 2019) demonstrated acceptable tolerance and a trend toward reduced mortality with hydrocortisone, without added long-term neurodevelopmental risk. Starting in June 2022, we added this protocol to our ongoing neonatal lung management bundle.

Objective: To evaluate the impact of adding SToP-BPD to our neonatal lung bundle on respiratory outcomes in preterm newborns < 29 weeks' gestational age in a North American level III NICU.

Design/Methods: We conducted a single-center cohort study (January 2021 - December 2023) including infants < 29 weeks' gestation, pre/post SToP-BPD addition to our lung bundle. The primary outcome was the incidence of BPD at 36 weeks postmenstrual age (PMA), classified per the 2018 NICHD criteria. Secondary outcomes included BPD severity, duration of mechanical and non-invasive ventilation, and corticosteroid exposure. Statistical analyses were performed using Chi-square, Fisher's exact, Mann-Whitney U, and unpaired t tests as appropriate, with significance set at p < 0.05.

Results: Maternal and neonatal characteristics were comparable in both groups. Adding SToP-BPD to our bundle did not significantly change the incidence of BPD at 36 weeks PMA (72.7% vs 71.3%; p = 0.87), and the distribution of BPD severity remained similar (mild 35% vs 30%; moderate 27% vs 33%; severe 10% vs 8%). Mechanical ventilation duration decreased significantly (-10.5; mean 35.7 days vs 25.2 days; p = 0.047), with earlier step-down in respiratory support from NAVA to CPAP modes (-13.1; mean 53.0 days vs 39.9 days; p = 0.020). There was a trend towards a reduction in the use of dexamethasone dose following implementation (p = 0.1).

Conclusion(s): Adding SToP-BPD to our neonatal lung bundle was associated with a shorter duration of mechanical and non-invasive ventilation, without increased morbidity or mortality. We also observed a trend toward reduced dexamethasone use post-implementation, known for its high toxicity. Hydrocortisone for neonatal respiratory management warrants further study and may contribute to improved steroid stewardship in this setting.

Table 1. Maternal and Infant Characteristics Before and After Implementation of the STOP-BPD Protocol
Comparison of baseline maternal and neonatal characteristics between pre-implementation and post-implementation groups (n = 103 per group). Data are presented as median (IQR) or number (%). P-values were calculated using Chi-square or Mann-Whitney U tests as appropriate.

Table 2. Impact of the STOP-BPD Protocol on Respiratory Outcomes in Extremely Preterm Infants
Respiratory outcomes before and after implementation of the STOP-BPD protocol. Data are expressed as mean (SD) or number (%). Differences and 95% confidence intervals are shown. P-values were calculated using unpaired t-tests, Chi-square or Fisher's exact test as appropriate. BPD severity classified according to the NICHD 2018 criteria.