Temporal trends of the use of dexamethasone for the treatment of bronchopulmonary dysplasia in very low-birth-weight preterm infants: a single-center evaluation.

Objective: To evaluate temporal trends in the use of dexamethasone for the treatment of bronchopulmonary dysplasia in very-low-birth-weight preterm infants.

Methods: A cohort study was conducted using an electronic database and medical records of all very low-birth-weight preterm infants admitted to a university tertiary neonatal unit between 2006 to 2022. The main outcome was the use of systemic dexamethasone to treat bronchopulmonary dysplasia, regardless of the dose or duration of treatment. Annual rates were evaluated using the Cochran-Armitage test.

Results: A total of 1,691 very-low-birthweight preterm infants were admitted during the study period, with a median birth weight of 1100 g (interquartile range [IQR] 850-1300g) and a median gestational age of 29 weeks (IQR= 27-31g). Infants exposed to dexamethasone were smaller (birth weight: 765 versus 1134g, p<0.001) and more immature (gestational age: 28 versus 31 weeks, p<0.001). The overall rate of dexamethasone use was 9.6% (annual variation 6.7% to 13.9%) and remained stable over the study period (p=0.287), including in infants aged <32 weeks (12.0%; p=0.203) and <28 weeks (24.6%; p=0.851). Mechanical ventilation and mortality rates remained stable at 58.8% (p=0.435) and 14.5% (p=0.078), respectively. However, the birth rate at <28 weeks of gestation increased (28.8%, annual variation of 16.0% to 43.8%, p<0.001).

Conclusion: Approximately one in 10 preterm very low-birth-weight infants and one in four of those <28 weeks received dexamethasone, with a trend towards stable use over time, despite a significant trend towards an increase in extreme preterm newborn infants.