Systemic corticosteroid use and neurodevelopmental outcomes in preterm infants: a cohort study.

Background: The risk-benefit balance and safety of postnatal corticosteroid use for chronic lung disease (PNCSCLD) in preterm infants is a controversial matter. Our objective was to determine the trends in the use of PNCSCLD over eleven years and to analyze the neurodevelopmental consequences of PNCSCLD in preterm infants at 18-42 months of corrected age.

Methods: The data for this retrospective population-based cohort study were obtained from ten tertiary neonatal intensive care units across New South Wales and the Australian Capital Territory, Australia. Preterm infants < 29⁺⁰ weeks' gestation born between January 1, 2007, and December 31, 2017, who were alive at discharge, without any major congenital anomalies were included and analyzed based on their PNCSCLD status.

Results: Over eleven years, 611 (14.3%) out of 4258 infants received PNCSCLD. Among the 3386 eligible infants, 2636 (77.8%) underwent neurodevelopmental follow-up and were included in the final analysis. The rate of PNCSCLD use increased from 12.4% in 2007 to 19.6% in 2017. Similarly, the rate of moderate to severe functional disability (MSFD) increased from 8.8% in 2007 to 16.1% in 2017. Propensity-adjusted analysis revealed a greater odds ratio (OR) for MSFD in the PNCSCLD group than in the control group [average treatment effect: OR = 1.252, 95% confidence interval (CI) = 1.185-1.322, P ≤ 0.001; average treatment effect on the treated group: OR = 1.104, 95% CI = 1.031-1.184, P = 0.005].

Conclusions: PNCSCLD use was associated with a greater incidence of MSFD. Clinicians should exercise caution when using PNCSCLD.