Bruk av postnatale kortikosteroider for å forebygge utvikling av bronkopulmonal dysplasi hos premature

Background and aims: Advances in neonatal care has led to increasing survival of premature infants. Despite this there is still a risk of developing bronchopulmonary dysplasia (BPD). Postnatal corticosteroids have been used to treat ventilator dependent infants, but there is a great concern about the possible long-term effects of this treatment. This thesis aims to discuss some relevant studies and present both beneficial and harmful effects of postnatal corticosteroids. Methods: This study is based on a literature search in Embase and Medline by using the text words (steroids, prematurity, respiratory failure) and MeSH terms. By discretionary assessment the relevant articles were extracted and read, which lead to the discovery of other relevant articles. Results: Metaanalyses of postnatal steroids compared to placebo show decreased mortality 28 days postnatal age (PNA) when corticosteroids are given after the first 7 days of life. It also shows reduced risk of BPD at 28 days PNA and 36 weeks postmenstrual age (PMA), both when corticosteroids are given early and late, and with a significant higher risk of BPD at 36 weeks PMA when moderate dosage is compared to higher doses. Both early and late treatment increases the chances of successful extubation at day 3, 7, 14 and 28. An increased risk of hypertension and hyperglycemia is demonstrated with early and late treatment, with increased risk of gastrointestinal complications or cerebral palsy only with early treatment. Several studies report increased risk of abnormal neurological examination. Conclusion: The benefits of corticosteroids might not outweigh the potential complications of the treatment. It is clear that the treatment should be restricted to those infants who remain dependent on mechanical ventilation, and only after the first week of life. It is a compelling need for more research to determine the right dosage, time and duration of the treatment, and the problem with long-term side effects and their impact on life