Glucocorticoid Treatment for Bronchopulmonary Dysplasia

Although there is supporting evidence that glucocorticoids improve the short-term pulmonary outcome of newborns, studies indicate significant long-term side effects with neurological sequelae. Corticosteroids can be administered by any route and the licensed products differ significantly in their pharmacological properties and (side) effects. Treatment schedules and dosing regimens vary significantly. Consequently, studies are difficult to compare and to summarise. However, to date, there is no dosing strategy which can always considered to be safe. This provides a dilemma for the treating clinician, who has to balance possible benefits against probable harms in individual patients. This book chapter will first highlight the general mechanism of action of corticosteroids both as natural hormones and as newly synthetised drugs. We will then focus on the function of corticoids during inflammation and their special role in lung development. We will present the clinical data and summarise the current evidence for glucocorticoid treatment strategies ranging from intravenous application to inhalation. Key aspects are the different treatment strategies with dexamethasone and hydrocortisone, because these are the most heavily used substances in newborns. We will take into account different modes of administration, different substances and dosing schedules before ending with some conclusions