Guidelines for use of corticosteroids in BPD
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Rationale
Based on recent publications demonstrating no clinical utility of steroid medications to improve mortality and long term outcome in infants with respiratory distress and evidence of bronchopulmonary dysplasia, we recommend that use of steroid medications be reserved for two situations:
For persistent hypotension unresponsive to volume expansion and vasopressor treatment. Consider hydrocortisone use. Documentation in the infant's medical record should support hydrocortisone use for recalcitrant hypotension. Parental agreement not required.
- Hydrocortisone 1 mg/kg as a one time dose. If infant has clinically significant response, one dose may be sufficient.
- Repeat above dose in 3-6 hours if no response.
- If acceptable response to first dose, consider one further dose of 1 mg/kg in 12 hours, or two further doses of 0.5 mg/kg at 12 hour intervals, then discontinue.
For severe life-threatening respiratory failure when other therapeutics interventions have failed to improve the infant. In this situation, the attending physician should document in the infant's medical record that a discussion was held with the family outlining the potential risks and limited evidence of benefit of steroid medications in such circumstances. If agreed to by the parent(s), consider a short course (3 days) of low-dose dexamethasone therapy as below:
- Day 1: 0.1 mg/kg every 12 hours times 2 doses
- Day 2: 0.075 mg/kg every 12 hours times 2 doses
- Day 3: 0.05 mg/kg every 12 hours times 2 doses
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