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Glucocorticoid Treatment for Bronchopulmonary Dysplasia

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Emerging Topics and Controversies in Neonatology

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Abstract

Although there is supporting evidence that glucocorticoids improve the short-term pulmonary outcome of newborns, studies indicate significant long-term side effects with neurological sequelae. Corticosteroids can be administered by any route and the licensed products differ significantly in their pharmacological properties and (side) effects. Treatment schedules and dosing regimens vary significantly. Consequently, studies are difficult to compare and to summarise. However, to date, there is no dosing strategy which can always considered to be safe. This provides a dilemma for the treating clinician, who has to balance possible benefits against probable harms in individual patients. This book chapter will first highlight the general mechanism of action of corticosteroids both as natural hormones and as newly synthetised drugs. We will then focus on the function of corticoids during inflammation and their special role in lung development. We will present the clinical data and summarise the current evidence for glucocorticoid treatment strategies ranging from intravenous application to inhalation. Key aspects are the different treatment strategies with dexamethasone and hydrocortisone, because these are the most heavily used substances in newborns. We will take into account different modes of administration, different substances and dosing schedules before ending with some conclusions.

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Abbreviations

ACTH:

Adrenocorticotropic hormone

aOR:

Adjusted odds ratio

BPD:

Bronchopulmonary dysplasia

BSID:

Bayley Scales of Infant Development

CI:

Confidence interval

CP:

Cerebral palsy

HPA:

Hypothalamic-pituitary-adrenal

NNT:

Number needed to treat

PMA:

Postmenstrual age

RCT:

Randomised controlled trial

RD:

Risk difference

ROP:

Retinopathy of prematurity

RR:

Risk reduction

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Authors and Affiliations

  1. Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Tanja Restin & Dirk Bassler

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  1. Tanja Restin
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  2. Dirk Bassler
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Correspondence to Dirk Bassler .

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Editors and Affiliations

  1. Department of Health Sciences, George Davies Centre for Medicine, University of Leicester, Leicester, UK

    Elaine M. Boyle

  2. Department of Health Sciences, George Davies Centre for Medicine, University of Leicester, Leicester, UK

    Jonathan Cusack

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Restin, T., Bassler, D. (2020). Glucocorticoid Treatment for Bronchopulmonary Dysplasia. In: Boyle, E., Cusack, J. (eds) Emerging Topics and Controversies in Neonatology. Springer, Cham. https://doi.org/10.1007/978-3-030-28829-7_15

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  • DOI: https://doi.org/10.1007/978-3-030-28829-7_15

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