Babies who are born preterm or have very low birth weight struggle to survive and need intensive care. Even if they do survive, they are at high risk of chronic lung disease and corticosteroids are one of the treatments used to prevent this. In an updated Cochrane Review from January 2017, Vibhuti Shah from the University of Toronto in Canada and colleagues have reviewed the latest evidence on the use of inhaled corticosteroids and tells us about it in this podcast.
John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. Babies who are born preterm or have very low birth weight struggle to survive and need intensive care. Even if they do survive, they are at high risk of chronic lung disease and corticosteroids are one of the treatments used to prevent this. In an updated Cochrane Review from January 2017, Vibhuti Shah from the University of Toronto in Canada and colleagues have reviewed the latest evidence on the use of inhaled corticosteroids and tells us about it in this podcast.
Vibhuti: In neonatal care, we are finding that chronic lung disease is an increasingly common complication for preterm infants despite the use of antenatal corticosteroids and postnatal surfactant. This is partly explained by increased survival of extremely low birth weight infants and there is an inverse relationship in the incidence of chronic lung disease with birth weight and gestational age, such that the incidence is highest in babies with lower birth weight and gestational age.
One of the ways to try to manage this is by tackling inflammation which plays an important role in the development of chronic lung disease. In many infants, an inflammatory reaction is evident shortly after birth suggesting that the process may have been triggered in their mother’s womb. Therefore, interventions aimed at the inflammatory process may reduce the incidence or severity of chronic lung disease. Giving the baby oral or intravenous corticosteroids is an attractive intervention strategy to achieve this goal because of their strong anti-inflammatory properties.
However, they can cause short-term complications such as hyperglycemia, hypertension and long-term serious complications including cerebral palsy and developmental delay. Theoretically, using inhaled corticosteroids so that the drug directly reaches the lung may allow for beneficial effects on the pulmonary system with a lower risk of undesirable systemic side effects.
Therefore, we’ve investigated whether administration of inhaled corticosteroids to preterm infants with birth weight up to 1500 grams beginning in the first two weeks after birth would prevent chronic lung disease, but we’ve found that this did not reduce the incidence of chronic lung disease at 36 weeks’ post-menstrual age. There was a significant reduction in the combined outcome of death or chronic lung disease at 36 weeks' postmenstrual age among all randomised babies and among survivors. However, even though the results are significant, the size of the benefit is very uncertain and is compatible with needing to treat every baby with inhaled steroids to prevent one baby dying or developing chronic lung disease by 36 weeks' postmenstrual age, which would not be acceptable in clinical practice.
In summary, our review shows that there is growing evidence that early administration of inhaled steroids to very low birth weight infants is effective in reducing the incidence of death or chronic lung disease. But, the clinical relevance is uncertain and long-term follow-up results for one of the studies, which was published in 2015, might affect our conclusions.
John: If you would like to read the current results of this latest version of this Cochrane Review, go online to Cochrane Library dot com and search ‘inhaled corticosteroids and neonates’.