261 - Factors associated with response after systemic corticosteroid treatment in invasively ventilated preterm infants

Publication Number: 261.4996

Gyeong Eun Yeom, Seoul National University Hospital, seoul, Seoul-t'ukpyolsi, Republic of Korea; Seung Han Shin, Seoul National University Hospital, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Han-Suk Kim, Seoul National University Children's Hospital, Jongno-gu, Seoul-t'ukpyolsi, Republic of Korea; Ee-Kyung Kim, Seoul National University Children's Hospital, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Ju Sun Heo, Seoul National University Children's Hospital, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Seh Hyun Kim, Seoul National University Children's Hospital, Seoul, Seoul-t'ukpyolsi, Republic of Korea

Background: Bronchopulmonary dysplasia (BPD) is a chronic lung disease in preterm infants. Since the late 1980s postnatal corticosteroids have been widely used for their strong anti-inflammatory effects to prevent and treat BPD. Studies have reported that early postnatal use of high-dose steroids increases the risk of neurodevelopmental impairments, including cerebral palsy, thus routine use is not recommended. As a result, clinicians are carefully weighing the risks and benefits when considering systemic steroid use in practice.

Objective: This study evaluated the factors associated with extubation failure after systemic corticosteroid (CS) therapy in preterm infants with established or evolving bronchopulmonary dysplasia (BPD).

Design/Methods: In this retrospective study, preterm infants with gestational age (GA) < 32 weeks and/or birthweight < 1500g, who admitted to Seoul National University Children’s Hospital in 2013 and 2023, and received systemic CS therapy for BPD were included. Participants were classified as responders when they were extubated within 14 days after the first dose of CS therapy. Perinatal and neonatal characteristics, as well as the respiratory severity score at the time of CS therapy and thereafter, were collected. Multivariate logistic regression analysis for non-responder was conducted.

Results: Among the 62 infants, 32 were responders, and 30 were non-responders. There were no significant differences in GA (25.9 vs. 25.5 weeks, p=0.262) and birth weight (753.6 vs. 698.0 grams, p=0.132) between the groups. Non-responders began CS therapy at a younger postmenstrual age (PMA) (29.2 vs. 31.0 weeks, p=0.011) and earlier postnatal day (PND) (27.6 vs. 37.0 days, p=0.016). Non-responders had higher rates of iNO therapy for pulmonary hypertension (15.6% vs. 66.7%, p< 0.001), more hemodynamically significant PDA (hsPDA) (3.1% vs. 30.0%, p=0.005), and higher RSS scores (4.54 vs. 6.87, p=0.001) at treatment initiation. RSS change (%) between day 1 and 4 was greater in responders (31.51 vs. 14.07, p=0.036). Multivariate analysis identified hsPDA (aOR 12.98, 95% CI 1.12-135.74, p=0.0323), pulmonary hypertension treatment (aOR 3.47, 95% CI 1.10-10.96, p=0.0339), day 1 RSS (aOR 1.46, 95% CI 1.01-2.10, p=0.0456) as significant factors.

Conclusion(s): day 1 RSS, hsPDA, and pulmonary hypertension were identified as key predictors of response to systemic CS therapy. In cases of BPD-PH, the efficacy of systemic CS may be reduced, indicating the need to prioritize before CS therapy.

Clinical Characteristics and neonatal morbidities of the group
Table 1.

Clinical characteristics at the timing of systemic CS
Table 2.

Multivariate analysis for the non-responder
Table 3. aOR: adjusted for GA, PND at 1st CS, D1 RSS, pulmonary HTN management at 1st CS, hsPDA at 1st CS