Impact of postnatal dexamethasone timing on preterm mortality and bronchopulmonary dysplasia: a propensity score analysis

Kwok, T'ng Chang; Szatkowski, Lisa; Sharkey, Don

Abstract

Introduction Postnatal dexamethasone (PND) is used in high-risk preterm infants after the first week of life to facilitate extubation and prevent bronchopulmonary dysplasia (BPD) but the optimal treatment timing remains unclear.

Objective Explore the association between the timing of PND commencement with mortality and respiratory outcomes.

Methods Retrospective National Neonatal Research Database study of 84,440 premature infants born below 32 weeks of gestational age from 2010–2020 in England and Wales. Propensity score weighting analysis was used to explore the impact of PND commenced at three timepoints (two to three weeks (PND2/3), four to five weeks (PND4/5) and after five weeks (PND6+) of chronological age) on the primary composite outcome of death before neonatal discharge and/or severe BPD (defined as respiratory pressure support at 36 weeks) alongside other secondary respiratory outcomes.

Results 3469 infants received PND. Compared to PND2/3, infants receiving PND6+ were more likely to die and/or develop severe BPD (OR 1.68, 95% CI 1.28–2.21), extubate at later postmenstrual age (mean difference 3.1 weeks, 95% CI 2.9–3.4), potentially require respiratory support at discharge (OR 1.34, 95% CI (1.06–1.70), but had lower mortality before discharge (OR 0.38, 95% CI 0.29–0.51). PND4/5 was not associated with severe BPD or discharge respiratory support.

Conclusion PND treatment after five weeks of age was associated with worse respiratory outcomes although residual bias cannot be excluded. A definitive clinical trial to determine the optimal PND treatment window, based on early objective measures to identify high-risk infants, is needed.

Citation

Kwok, T. C., Szatkowski, L., & Sharkey, D. (2023). Impact of postnatal dexamethasone timing on preterm mortality and bronchopulmonary dysplasia: a propensity score analysis. European Respiratory Journal, 62(4), Article 2300825. https://doi.org/10.1183/13993003.00825-2023

• Journal Article Type: Article
• Acceptance Date: Aug 8, 2023
• Online Publication Date: Aug 17, 2023
• Publication Date: Oct 1, 2023
• Deposit Date: Aug 23, 2023
• Publicly Available Date: Aug 18, 2024
• Journal: European Respiratory Journal
• Print ISSN: 0903-1936
• Electronic ISSN: 1399-3003
• Publisher: European Respiratory Society
• Peer Reviewed: Peer Reviewed
• Volume: 62
• Issue: 4
• Article Number: 2300825
• DOI: https://doi.org/10.1183/13993003.00825-2023
• Keywords: Bronchopulmonary dysplasia, preterm, respiratory, dexamethasone
• Public URL: https://nottingham-repository.worktribe.com/output/24424080