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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

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