Abstract
Objective Intercenter variation and trends in postnatal steroids (PNS) use among preterm infants
for prevention or treatment of bronchopulmonary dysplasia (BPD) is known. Understanding
intracenter PNS use patterns facilitate implementation of center-specific change interventions
to optimize outcomes.
This study aimed to (i) quantify the proportion of infants who received PNS, and describe
the timing, type, trends over time, regimen used, and deviations, and (2) describe
the clinical characteristics and unadjusted outcomes of infants who received PNS.
Study Design This was a cohort study in a quaternary neonatal intensive care unit including infants
born at less than 33 weeks, and who received PNS for prevention or treatment of BPD
between 2011 and 2021. Following data were included: proportion of babies who received
PNS; type of PNS; age at initiation and duration; trends over time; deviation from
published regimen; morbidity, mortality, and cointerventions.
Results One hundred and eighty four infants (8% of <33 week' infants) received PNS. The median
(interquartile range [IQR]) gestational age and birth weight were 25 (24–26) weeks
and 720 (625–841) grams, respectively. The median (IQR) day of initiation and duration
of PNS use were 29 (19–38) and 10 (10–22) days, respectively. One hundred and fifty-seven
(85%) infants received dexamethasone (DX) and 22 (12%) received hydrocortisone as
the first PNS course, and 71 (39%) infants received multiple courses. The proportion
of infants receiving PNS remained unchanged, but the cumulative median dose received
for BPD per patient increased by 56%. Nearly one-third of cumulative PNS dose came
from PNS used for non-BPD indications. Forty-six percent infants had a deviation from
published regimen (±20% deviation in duration or ±10% deviation in dose). Survival,
survival without major morbidity, moderate-to-severe BPD, and technology dependence
at discharge were 87, 2, 91, and 67%, respectively.
Conclusion Increased variation in PNS use, deviation from published regimen, and concurrent
PNS exposure from non-BPD indication offer insights into implementing interventions
to improve processes.
Key Points
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In this quaternary NICU, 8% of infants born before 33 weeks were administered postnatal
steroids (PNS).
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The percentage of infants given PNS remained stable; however, the cumulative dose
per patient for BPD rose.
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The study identified targeted interventions to minimize clinical practice variations
at the center.
Keywords
bronchopulmonary dysplasia - postnatal steroids - neonatal intensive care - variation
