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Factors associated with the response to postnatal dexamethasone use in very low birthweight infants: a nationwide cohort study

 Seung Hwan Baek  ;  Jeong Eun Shin  ;  Jungho Han  ;  In Gyu Song  ;  Joonsik Park  ;  Su Min Lee  ;  Sungbo Shim  ;  Ho Seon Eun  ;  Soon Min Lee  ;  Joohee Lim  ;  So Jin Yoon  ;  Wook Chang  ;  Min Soo Park 
 BMJ PAEDIATRICS OPEN, Vol.7(1) : e002302, 2023-12 
Journal Title
Issue Date
Bronchopulmonary Dysplasia* / complications ; Bronchopulmonary Dysplasia* / drug therapy ; Bronchopulmonary Dysplasia* / epidemiology ; Cohort Studies ; Dexamethasone / therapeutic use ; Ductus Arteriosus, Patent* / chemically induced ; Ductus Arteriosus, Patent* / drug therapy ; Ductus Arteriosus, Patent* / epidemiology ; Female ; Humans ; Hypertension, Pulmonary* / chemically induced ; Hypertension, Pulmonary* / complications ; Hypertension, Pulmonary* / drug therapy ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Pregnancy
Epidemiology ; Neonatology
Background: Dexamethasone is widely used as a systemic corticosteroid to treat and prevent bronchopulmonary dysplasia (BPD) in preterm infants. We evaluated the current epidemiology of dexamethasone use to prevent BPD and analyse the factors associated with the response to dexamethasone in very low birthweight infants using a nationwide database.

Methods: We included very low birthweight infants born between January 2013 and December 2020 with a gestational age of 23-31 weeks using data from the Korean Neonatal Network registry. Patients were grouped based on their dexamethasone use into 'Dex' or 'No Dex' groups. Clinical variables and data were collected, and the annual trends of dexamethasone use and the proportion of patients who received dexamethasone according to gestational age were analysed. Respiratory outcomes were compared between the groups. Univariate and multivariate analyses were performed to analyse factors associated with the response to dexamethasone in BPD.

Results: Of 11 261 eligible infants, 2313 (20.5%) received dexamethasone, and 1714 (74.1%) of them were diagnosed with moderate-to-severe BPD. The 8-year annual prevalence of dexamethasone use was 17.7-22.3%. The 'Dex' group had more moderate-to-severe BPD, more frequent invasive ventilation use at a postmenstrual age of 36 weeks and longer ventilator duration. Birth weight, 5-minute APGAR score, pulmonary hypertension within the first 28 days, surgical treatment of patent ductus arteriosus, medical treatment of patent ductus arteriosus, pathological chorioamnionitis, hydrocortisone or budesonide use, surgical management of necrotising enterocolitis and fungal sepsis were associated with BPD after dexamethasone use.

Conclusions: Approximately 20.5% of preterm infants received dexamethasone, and the frequency increased as gestational age decreased. Poor response to dexamethasone was associated with antenatal and postnatal inflammation, low birth weight and early pulmonary hypertension.
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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
Yonsei Authors
Park, Min Soo(박민수) ORCID logo https://orcid.org/0000-0002-4395-9938
Park, Joon Sik(박준식) ORCID logo https://orcid.org/0000-0002-4902-4770
Baek, Seung Hwan(백승환)
Song, In Gyu(송인규) ORCID logo https://orcid.org/0000-0002-3205-9942
Shin, Jeong Eun(신정은) ORCID logo https://orcid.org/0000-0002-4376-8541
Shim, Sungbo(심성보)
Yoon, So Jin(윤소진) ORCID logo https://orcid.org/0000-0002-7028-7217
Eun, Ho Seon(은호선) ORCID logo https://orcid.org/0000-0001-7212-0341
Lee, Su Min(이수민)
Lee, Soon Min(이순민) ORCID logo https://orcid.org/0000-0003-0174-1065
Lim, Joo Hee(임주희) ORCID logo https://orcid.org/0000-0003-4376-6607
Chang, Wook(장욱)
Han, Jung Ho(한정호) ORCID logo https://orcid.org/0000-0001-6661-8127
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