[Skip to Navigation]
Views 437
Citations 0
Comment & Response
July 6, 2021

Is a New Era Coming for Bronchopulmonary Dysplasia Prevention With Corticosteroids?—Reply

Author Affiliations
  • 1Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 2Department of Pediatric, University of Cincinnati College of Medicine, Cincinnati, Ohio
JAMA Pediatr. 2021;175(10):1080-1081. doi:10.1001/jamapediatrics.2021.1864

In Reply I thank Bonadies et al for their thoughtful letter and for requesting that I expound on my recommendation1 to use low–cumulative–dose (less than 2 mg/kg) dexamethasone, initiated as soon as possible after the first postnatal week for clinical prevention of bronchopulmonary dysplasia (BPD). A low-dose dexamethasone regimen has greater neurodevelopmental safety data and is fairly well accepted by clinicians and recommended by current guidelines.2-4 Therefore, more consistent and earlier use of low-dose dexamethasone may be the right place to start. Compared with data from before 2002, more recent data on postnatal corticosteroids suggest a 4-fold decrease in use and, when it is used sparingly, it is typically with low-dose hydrocortisone or late-initiated (after 30 days) low-dose dexamethasone in extremely preterm infants.2,3 Earlier initiation of anti-inflammatory medications is consistent with meta-analysis evidence of greater risk reduction in death or BPD.5 Consistent use of dexamethasone in all eligible high-risk preterm infants may also reverse the significantly higher rates of any BPD and severe BPD observed with lower prescribing rates of dexamethasone over time.3

Add or change institution
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words