2 research outputs found
Systemic Steroids in Preventing Bronchopulmonary Dysplasia (BPD): Neurodevelopmental Outcome According to the Risk of BPD in the EPICE Cohort
Background: Postnatal steroids (PNS) have been used to prevent bronchopulmonary
dysplasia (BPD) in preterm infants but have potential adverse effects on neurodevelopment. These
effects might be modulated by their risk of BPD. We aimed to compare patients’ neurodevelopment
with PNS treatment according to their risk of BPD in a European cohort. Methods: We developed
a prediction model for BPD to classify infants born between 24 + 0 and 29 + 6 weeks of gestation
in three groups and compared patients’ neurological outcome at two years of corrected age using
the propensity score (PS) method. Results: Of 3662 neonates included in the analysis, 901 (24.6%)
were diagnosed with BPD. Our prediction model for BPD had an area under the ROC curve of 0.82.
In the group with the highest risk of developing BPD, PNS were associated with an increased risk
of gross motor impairment: OR of 1.95 after IPTW adjustment (95% CI 1.18 to 3.24, p = 0.010). This
difference existed regardless of the type of steroid used. However, there was an increased risk of
cognitive anomalies for patients treated with dexa/betamethasone that was no longer observed
with hydrocortisone. Conclusions: This study suggests that PNS might be associated with an
increased risk of gross motor impairment regardless of the group risk for BPD. Further randomised
controlled trials exploring the use of PNS to prevent BPD should include a risk-based evaluation
of neurodevelopmental outcomes. This observation still needs to be confirmed in a randomised
controlled trial
Systemic Steroids in Preventing Bronchopulmonary Dysplasia (BPD): Neurodevelopmental Outcome According to the Risk of BPD in the EPICE Cohort
Background: Postnatal steroids (PNS) have been used to prevent bronchopulmonary dysplasia (BPD) in preterm infants but have potential adverse effects on neurodevelopment. These effects might be modulated by their risk of BPD. We aimed to compare patients’ neurodevelopment with PNS treatment according to their risk of BPD in a European cohort. Methods: We developed a prediction model for BPD to classify infants born between 24 + 0 and 29 + 6 weeks of gestation in three groups and compared patients’ neurological outcome at two years of corrected age using the propensity score (PS) method. Results: Of 3662 neonates included in the analysis, 901 (24.6%) were diagnosed with BPD. Our prediction model for BPD had an area under the ROC curve of 0.82. In the group with the highest risk of developing BPD, PNS were associated with an increased risk of gross motor impairment: OR of 1.95 after IPTW adjustment (95% CI 1.18 to 3.24, p = 0.010). This difference existed regardless of the type of steroid used. However, there was an increased risk of cognitive anomalies for patients treated with dexa/betamethasone that was no longer observed with hydrocortisone. Conclusions: This study suggests that PNS might be associated with an increased risk of gross motor impairment regardless of the group risk for BPD. Further randomised controlled trials exploring the use of PNS to prevent BPD should include a risk-based evaluation of neurodevelopmental outcomes. This observation still needs to be confirmed in a randomised controlled trial