Are you using a steroid course in infants who are 36+ weeks CGA with BPD, who are not weaning on non-invasive ventilation? The group I am considering is 36-40 weeks CGA, who remain on CPAP with some oxygen requirement (~30%) and work of breathing/tachypnea who are not progressing. If so, which steroid (Decadron, Hydrocortisone, Prednisone, etc) and do you have a regimen?

Thank you!

I have used Prednisone successfully to wean this group of babies off their non-invasive respiratory support. The regimen IO have used is the Bhandari one (Bhandari A, Schramm CM, Kimble C, et al. Effect of a Short Course of Prednisolone in Infants With Oxygen-Dependent Bronchopulmonary Dysplasia. Pediatrics. 2008;121:e344–9. doi: 10.1542/peds.2006-3668). basically, Prednisolone 1 mg/kg BD x 5 days, then 1 mg/kg OD for 3 days and then 1 mg/kg OD on alternate days for 3 doses. This has resuklted in babies being weaned off CPAP/High Flow Oxygen onto low-flow nasal cannula oxygen enabling them to be discharged on home oxygen.

We use but not in babies you mentioned. Cpap with 30% should come out of it in due time. Steroid reserved for grade 1 bpd

How long should one wait for a baby to come off nasal prong O2 post 36 weeks CGA

9 hours ago, chandas said:

I have used Prednisone successfully to wean this group of babies off their non-invasive respiratory support. The regimen IO have used is the Bhandari one (Bhandari A, Schramm CM, Kimble C, et al. Effect of a Short Course of Prednisolone in Infants With Oxygen-Dependent Bronchopulmonary Dysplasia. Pediatrics. 2008;121:e344–9. doi: 10.1542/peds.2006-3668). basically, Prednisolone 1 mg/kg BD x 5 days, then 1 mg/kg OD for 3 days and then 1 mg/kg OD on alternate days for 3 doses. This has resuklted in babies being weaned off CPAP/High Flow Oxygen onto low-flow nasal cannula oxygen enabling them to be discharged on home oxygen.

I use the same regimen in babies with BPD Grade 1-2, and my experience so far has been successful weaning in more than 70% of the time. I don't repeat the course of Prednisolone if I'm not able to wean off with the first course.

Hi,

Sometimes steroids are used in this situation, but I tend to be cautious about it.

Most of the evidence for postnatal steroids comes from studies in very preterm infants who remain mechanically ventilated, where steroids can improve lung mechanics and facilitate extubation. The DART trial, for example, was specifically designed to help chronically ventilated infants achieve extubation. It did not study infants who are already extubated and on non-invasive support, so applying that evidence to babies at 36–40 weeks CGA on CPAP is largely an extrapolation.

For infants with established BPD who are already extubated, the evidence that systemic steroids meaningfully change the overall trajectory of the disease is quite limited. In my experience they may produce some transient improvement in respiratory mechanics, but the effect is often short-lived and oxygen requirements may increase again afterwards. Given the potential side effects, I am not convinced they provide sustained benefit in this group.

in babies who are already extubated and on CPAP at ≥36 weeks CGA, I am not aware of strong evidence that systemic steroids significantly alter outcomes, and therefore I tend to use them very cautiously.

Again it depends on your unit rate of bpd, if > 70% steroids mainly dexa help in long term NDI but if <30% it harms. Your baby at 36wks on Ncap 6, 30% steroids are not at all recommended. Wait 40-44 wks, if still send home on oxygen via cannula it all depends where you work and how is community support and parents wishes

I would usually try inhaled steroids first…have had pretty good success. If that didn’t work then a short course of prednisone, similar to what would be used for asthma.

Jody R Gross, MD