Objective: To assess changes in the incidence of bronchopulmonary dysplasia (BPD) in extremely preterm infants at UNMH after implementation of routine use of prophylactic hydrocortisone. The secondary objective is to assess for possible complications that can occur with the treatment of steroids, including the presence of spontaneous gastrointestinal perforation, late onset sepsis, significant hyperglycemia, and significant hypertension.
Background: BPD is the leading cause of morbidity and mortality in preterm infants and has been found to be an independent risk factor for poor neurodevelopmental outcomes in extremely premature infants. Hydrocortisone has been shown to be effective in improving survival and decreasing BPD at 36 weeks postmenstrual age (PMA) and is safer in terms of neurodevelopmental outcomes than dexamethasone, the previous treatment of choice. Prophylactic hydrocortisone utilization to prevent BPD was adopted as standard of care in the Newborn Intensive Care Unit (NICU) at the University of New Mexico Hospital (UNMH) in 2018. We hypothesize that since the implementation of routine use of hydrocortisone in 2018, there has been a ten percent decrease in the diagnosis of BPD, defined as any oxygen use at 36 weeks corrected gestational age, at the UNMH NICU.
Methods: To determine the change in the incidence of BPD, we will compare the incidence of BPD in the UNMH NICU before and after implementing routine use of prophylactic hydrocortisone for all infants born at <29 weeks’ gestational age. We plan to review charts of extremely preterm infants (born <29 week’s gestation) from January 1, 2017 to July 31, 2018 (before routine prophylactic hydrocortisone use) and from December 1, 2018 to June 30, 2020 (after start of routine prophylactic hydrocortisone treatment for all infants born at <29 weeks’ gestational age).
Next steps: IRB approval has been obtained, chart review is completed, and the statistical analysis is in process.
Wilcken, Jessica; Dawn Novak; Conra Lacy; and Cheng Chen. "Early Hydrocortisone Administration for Bronchopulmonary Dysplasia Prevention." (2021). https://digitalrepository.unm.edu/hsc_2021_pediatric_research/9