Rescue therapy with betamethasone in preterm infants (day of life>14) at high risk for bronchopulmonary dysplasia to assist weaning from ventilator support: a case series

Abstract

Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease (CLD) that is a major sequel of respiratory distress syndrome (RDS) associated with significant neonatal mortality and long-term morbidity in survivors. The incidence is highest in babies born at less than 28 weeks of gestational who have severe respiratory distress at birth, particularly in those who require respiratory support with oxygen and positive-pressure ventilation for more than two weeks after birth.1 Despite the high prevalence of BPD among the increasingly immature population of infants surviving preterm birth, no drugs for prevention have been licensed.2 Persistent lung inflammation is the most likely mediator of lung injury contributing to the development of BPD.1 The role of corticosteroids as anti-inflammatory agents has been extensively studied and proven to be efficacious in the management of neonatal respiratory disorders, although use is associated with many short and long-term side effects.1 Research has proven that prenatal steroids are an inexpensive, safe and highly effective way of enhancing neonatal survival, reducing morbidity, decreasing the incidence and severity of RDS, and decreasing the incidence of intra ventricular hemorrhage and necrotizing enterocolit is in babies born prematurely.2 Although postnatal steroids are recognized to reduce rates of BPD, usage has been more controversial due to uncertainty regarding safety.2–7 In the late 1990s, reports on long-term outcomes showed early postnatal systemic dexamethasone treatment was associated with an increased risk of abnormal neurological