Abstract
Aim Bronchopulmonary dysplasia (BPD) is a chronic lung disease that is more common in premature newborns and occurs with the addition of triggering mechanisms such as mechanical ventilation and oxygen exposure during the intensive care period to the inflammation caused by events such as maternal infection and/or chorioamnionitis in the antenatal period. Corticosteroid use has been proven to be beneficial for the prevention of postnatal BPD due to its anti-inflammatory properties. In this study, we aimed to show the changes in lung ultrasonography (LUS) findings before, during and after corticosteroid use in premature newborn infants born at 32 weeks and younger who are predicted to have BPD.
Material and Method In this study, DART (Dexamethasone: A Randomized Trial) protocol was administered to patients born between January 2022 and 2024 below 32 weeks of gestation who were on invasive mechanical ventilation on or after the 14th postnatal day, or hydrocortisone protocol was administered to patients who needed noninvasive mechanical ventilation or required fractional oxygen concentration (FiO2) above 35–40% to achieve target saturation values. LUS was performed at the beginning of treatment, on the 3rd day, at the end of treatment and at discharge, and characteristics and scores were recorded. Repeated measurements were evaluated statistically.
Results Corticosteroid treatment and LUS were performed in 20 patients included in the study. The mean gestational age was 29±1.5 weeks, birth weight was 1282±234 grams. The median day of corticosteroid initiation was 29.5 (14–62) and three patients were treated with dexamethasone and 17 with hydrocortisone. There was a statistical difference between the oxygen requirement, LUS scores and pulmonary edema appearance between the first and last day of corticosteroid use (p:0.02, p:0.002, p<0.001, respectively). Between Day 1 and Day 3, there was a significant decrease in oxygen requirement (p<0.001) and a significant difference in LUS scores and pulmonary edema appearance (p<0.001, p:0.002, respectively), whereas no difference was found between Day 3, last day and discharge scores and oxygen requirement (table 1). The pressure requirements of the patients who needed pressure decreased significantly before and after corticosteroids (9 (45%), 1 (5%), respectively; p<0.001). The length of stay of patients on noninvasive mechanical ventilation (NIMV) decreased significantly before and after treatment (7.5 (1–20), 0 (0–5), respectively; p<0.001).
Conclusions We found that the acute effects of corticosteroid treatment contributed to clinical improvement and improvement in LUS findings. This study helped us to understand more clearly the positive effects of corticosteroid treatment in patients predicted to develop BPD.
