Use of postnatal corticosteroids and weight gain in extremely prematurely born infants

Abstract

Introduction: Preterm infants often require invasive ventilatory support and can develop chronic pulmonary morbidity. Postnatal corticosteroids can improve respiratory function and facilitate extubation, yet their catabolic effects may adversely affect growth.

Aim: To determine the effect of postnatal steroids on growth at 36 weeks PMA and NICU discharge.

Methods: A study was undertaken of all extremely preterm infants in England born between 2014 and 2018. Infants were classified as treated with corticosteroids if they received either dexamethasone or hydrocortisone for at least five consecutive days. Postnatal growth was calculated as the difference in weight z-score from birth to both 36 weeks PMA and discharge using the UK-WHO preterm growth chart.

Results: The population comprised 11,744 infants; 2331 infants were exposed to postnatal corticosteroids (19.8%). The median gestational age at birth of infants receiving postnatal corticosteroids was lower than that of infants not receiving postnatal steroids (25.0 versus 26.6 weeks; p<0.001). Regression analysis demonstrated exposure to postnatal steroids was independently associated with increased postnatal weight gain from birth to discharge (95% CI 0.07 to 0.19; p<0.001), but no significant weight gain difference from birth to 36 weeks PMA (95% CI -0.02 to 0.07; p=0.32). Infants receiving more than one course of corticosteroids had similar postnatal weight gain to those infants receiving only one course (p=0.87).

Conclusion: Postnatal corticosteroid treatment was not associated with growth impairment. Long term metabolic and neurodevelopmental consequences of postnatal corticosteroid treatment do however need to be studied.