Current Concepts of Corticosteroids Use for the Prevention of BronchopulmonaryDysplasia

Abstract: Despite using antenatal steroids, surfactants and protective ventilation, bronchopulmo-nary dysplasia (BPD) affects 10-89% of preterm infants. Since lung inflammation is central to the BPD pathogenesis, postnatal systemic corticosteroids could reduce the risk of BPD onset in preterm infants, but short and long-term adverse consequences have been underlined in literature after their use (i.e., hyperglycaemia, hypertension, hypertrophic cardiomyopathy, growth failure, gastrointesti-nal bleeding, cerebral palsy). Alternative therapeutic strategies such as postponing corticosteroid administration, lowering the cumulative dose, giving pulse rather than continuous doses, or individ-ualizing the dose according to the respiratory condition of the infant have been proposed to avoid their adverse effects. Dexamethasone remains the first-line drug for newborns with severe pulmo-nary disease beyond the second to the third week of life. Hydrocortisone administration in very pre-term infants does not appear to be associated with neurotoxic effects, even if its efficacy in prevent-ing and treating BPD has yet been clearly demonstrated. Alternative methods of corticosteroid ad-ministration seem promising. A positive effect on BPD prevention occurs when budesonide is nebu-lized and intratracheally instilled with a surfactant, but more data are required to establish safety and efficacy in preterm newborns. Additional studies are still needed before the chronic lung dis-ease issue, and its related challenges can be solved.