Dexamethasone treatment after the first week of life for bronchopulmonary dysplasia in preterm infants: a systematic review

Background: Dexamethasone has powerful anti-inflammatory effects and has been used to treat established bronchopulmonary dysplasia (BPD), but it is uncertain whether the benefits outweigh the risks of treatment.

Objectives: To determine the effect of late (>7 days) postnatal dexamethasone treatment compared with control (placebo or nothing) to prevent or treat BPD in the preterm infant.

Methods: Randomised controlled trials (RCTs) of late postnatal dexamethasone therapy to treat or prevent BPD were sought using methods of the Cochrane Collaboration. Data regarding clinical outcomes including mortality, BPD, death or BPD, complications during the primary hospitalisation, and long-term outcome were abstracted and analysed using RevMan 5.

Results: 19 RCTs enrolling 1,345 participants were eligible for this review. Late dexamethasone treatment reduced neonatal mortality, but not later mortality. Benefits of late dexamethasone included reductions in failure to extubate, BPD and the combined outcome of death or BPD. There were clear short-term complications, including hyperglycaemia and hypertension, but not intestinal perforation. Trends of an increase in cerebral palsy or abnormal neurological examination were partly offset by a trend in the opposite direction in death before late follow-up.

Conclusions: The benefits of late dexamethasone may not outweigh actual or potential adverse effects. Given the evidence of both benefits and harms of treatment, and the limitations of the evidence at present, it appears prudent to reserve the use of late dexamethasone to infants who cannot be weaned from mechanical ventilation, and to minimise the dose and duration of any course of treatment.