Side Effects of Long Term Steroid Therapy in Chronic Lung Disease

Respiration ◽  
1970 ◽  
Vol 27 (1) ◽  
pp. 280-281
Author(s):  
K.F. Kerrebijn
Keyword(s):  
Side Effects ◽  
Lung Disease ◽  
Steroid Therapy ◽  
Chronic Lung Disease

Letter To The Editor

PEDIATRICS ◽  
1996 ◽  
Vol 98 (4) ◽  
pp. 799-800
Author(s):  
Manuel Durand ◽  
Smeeta Sardesai ◽  
Cindy McEvoy
Keyword(s):  
Birth Weight ◽  
Side Effects ◽  
Low Birth Weight ◽  
Steroid Therapy ◽  
Chronic Lung Disease ◽  
Very Low Birth Weight ◽  
Vlbw Infants ◽  
Cardiac Side Effects ◽  
Dexamethasone Therapy

We thank Dr Zecca and associates for their interest in our paper.1 Their concerns regarding possible cardiac side effects during steroid therapy in very low birth weight (VLBW) infants are quite appropriate and, we feel, further emphasize the benefits of an "early" (mean postnatal age, 9 to 10 days) and "short" (7 days) course of dexamethasone therapy for this group of infants at risk for long-term pulmonary morbidities. The prior studies they have referenced2-5 and another recent study6 applied longer courses of steroid therapy (up to 42 days) to infants with well-established chronic lung disease (CLD).

Neonatal Chronic Lung Disease

2001 ◽  
Vol 14 (3) ◽  
pp. 181-206
Author(s):  
Minyon Avent ◽  
Diana Coile ◽  
Letha Mathai
Keyword(s):  
Lung Disease ◽  
Steroid Therapy ◽  
Chronic Lung Disease ◽  
Periventricular Leukomalacia ◽  
Treatment Modalities ◽  
Positive Pressure ◽  
Treatment Needs ◽  
Long Term Outcomes ◽  
Radiographic Findings

Chronic lung disease (CLD), formerly known as bronchopulmonary dysplasia, is presently defined as the need for oxygen therapy either at 28 days of age or greater than 36 weeks postmenstrual age. Clinical signs and symptoms include tachypnea, retractions, apnea, and radiographic findings of poorly inflated lungs with reticulogranular opacities. The disease develops as a result of chronic pulmonary inflammation and continuous lung injury induced by oxygen, positive pressure ventilation, and other causes. Fifty to sixty-five percent of neonates with CLD are rehospitalized with respiratory problems, and 21% of very low birth weight neonates are diagnosed with asthma or other respiratory disorders by the age of five. These infants are at risk of adverse neurodevelopmental sequelae as they have a more complicated neonatal course. Many studies have explored various preventive therapies including α1-proteinase inhibitors, superoxide dismutase, antioxidants, and ventilatory management. Although the results from these trials are promising, further studies are needed to define which patients are most likely to benefit from preventive therapy. Two preventive treatment approaches that have shown a decrease in morbidity and an improvement in mortality are antenatal steroids and surfactant therapy. Postnatal corticosteroid therapy continues to be the mainstay of treatment for CLD, however, there are a number of detrimental side effects associated with this treatment. Due to the increased incidence in periventricular leukomalacia, early treatment of steroid therapy cannot be recommended. The optimal time to start steroid therapy appears to be after the first week of life. In addition, the lowest dose and shortest duration of treatment needs to be implemented in order to minimize potential complications. Although bronchodilators and diuretics continue to be used extensively in infants with CLD, there are surprisingly few well-controlled studies that have evaluated the clinical impact of this therapy. Further trials are needed in order to support the routine use of these therapies in CLD. Unfortunately, inhaled steroids have not shown an improvement in long-term outcomes of CLD, however, they have shown a decrease in systemic steroid usage. CLD is a complex disease with many unanswered questions. Further studies are needed to evaluate the effects of various treatment modalities with particular focus on the long-term outcomes such as oxygen and ventilator dependency as well as the incidence of CLD.

Long-term follow-up of chronic lung disease of infancy

2004 ◽  
Vol 37 (S26) ◽  
pp. 106-107 ◽  
Author(s):  
Teresa Bandeira ◽  
Teresa Nunes
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Long Term Follow Up

scholarly journals Early Changes and Indicators Characterizing Lung Aging in Neonatal Chronic Lung Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Jennifer Sucre ◽  
Lena Haist ◽  
Charlotte E. Bolton ◽  
Anne Hilgendorff
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Health Care Professionals ◽  
Treatment Strategies ◽  
Oxygen Toxicity ◽  
Growth Factor Signaling ◽  
Inflammatory Processes ◽  
Long Term Consequences ◽  
Neonatal Chronic Lung Disease

Infants suffering from neonatal chronic lung disease, i.e., bronchopulmonary dysplasia, are facing long-term consequences determined by individual genetic background, presence of infections, and postnatal treatment strategies such as mechanical ventilation and oxygen toxicity. The adverse effects provoked by these measures include inflammatory processes, oxidative stress, altered growth factor signaling, and remodeling of the extracellular matrix. Both, acute and long-term consequences are determined by the capacity of the immature lung to respond to the challenges outlined above. The subsequent impairment of lung growth translates into an altered trajectory of lung function later in life. Here, knowledge about second and third hit events provoked through environmental insults are of specific importance when advocating lifestyle recommendations to this patient population. A profound exchange between the different health care professionals involved is urgently needed and needs to consider disease origin while future monitoring and treatment strategies are developed.

The Use of Dexamethasone in Premature Infants at Risk for Bronchopulmonary Dysplasia or Who Already Have Developed Chronic Lung Disease: A Cautionary Note

PEDIATRICS ◽  
1991 ◽  
Vol 88 (2) ◽  
pp. 414-415
Author(s):  
KENNETH L. HARKAVY
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Meta Analysis ◽  
Cautionary Note ◽  
Short Treatment ◽  
Treatment Regimens ◽  
Length Of Treatment ◽  
Term Benefit ◽  
Combined Data

In Reply.— The letter-to-the-editor from Dr Frank is a cautionary note about the risks of glucocorticoid therapy for chronic lung disease in infants. These concerns are real and have been enumerated in most papers on the subject. Only one study to date has suggested a long-term benefit (decreased mortality); yet consistently respiratory therapy support is decreased by steroid use. I have performed a limited meta-analysis because all studies have had similar enrollment criteria and treatment regimens. Two lengths of treatment have been compared and the combined data compared with the controls (Table 1). [See table in the PDF file] This analysis suggests that there is no major difference in outcome by length of treatment, although short treatment was associated with less hyperglycemia and longer duration of intubation. Comparison of all steroid-treated patients with placebo-treated babies showed treated infants had more hyperglycemia (P < .01 χ2) but an average of 11 fewer days of mechanical ventilation (intermittent mandatory ventilation, ImV). (t test was not done due to lack of raw data; however, difference was significant in each subgroup.)

scholarly journals Postnatal hydrocortisone treatment for chronic lung disease in the preterm newborn and long-term neurodevelopmental follow-up

2008 ◽  
Vol 93 (1) ◽  
pp. F58-F63 ◽  
Author(s):  
K J Rademaker ◽  
L S de Vries ◽  
C S P M Uiterwaal ◽  
F Groenendaal ◽  
D E Grobbee ◽  
...  
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Preterm Newborn ◽  
Hydrocortisone Treatment

scholarly journals Corticosteroids in infant chronic lung disease

2004 ◽  
Vol 61 (3) ◽  
Author(s):  
C. May ◽  
A. Greenough
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Alternative Therapy ◽  
Neurodevelopmental Outcome ◽  
Health Care Utilisation ◽  
Respiratory Morbidity ◽  
Care Utilisation ◽  
Acute Side Effects ◽  
Postmenstrual Age

Chronic lung disease (CLD), defined as chronic oxygen dependency at 36 weeks postmenstrual age, is increasing and associated with chronic respiratory morbidity and high health care utilisation at follow up. Many strategies, tested in randomised trials, have failed to reduce CLD. In contrast, corticosteroids if given systemically within the first two weeks after birth reduce CLD and may also favourably influence survival. Unfortunately, systemically administered corticosteroids have many acute side-effects and adversely affect long term neurodevelopmental outcome. If given by inhalation, corticosteroids have fewer adverse effects, but are less efficacious. Further research is required to accurately identify infants at highest risk of developing CLD, the corticosteroid dosage associated with a positive risk: benefit ratio and preferably a safer and more effective alternative therapy.

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