Post-natal corticosteroids are associated with reduced expiratory flows in children born very preterm

• Published in: Journal of paediatrics and child health 2011-07, Vol.47 (7), p.448-454
• Main Authors: Smith, Lucia J, van Asperen, Peter P, McKay, Karen O, Selvadurai, Hiran, Fitzgerald, Dominic A
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Age; air flow; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - adverse effects; bronchopulmonary dysplasia; Bronchopulmonary Dysplasia - prevention & control; Child; Child development; Children; Cohort Studies; corticoids; corticosteroid; Cross-Sectional Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug therapy; Female; Humans; Infant, Newborn; Infant, Premature; Infants; Linear Models; Lung; Male; outcome; Premature birth; prematurity; Respiratory function; Respiratory Function Tests; Respiratory Physiological Phenomena - drug effects; Retrospective Studies; schools; spirometry; Steroids
• ISSN: 1034-4810; 1440-1754
• DOI: 10.1111/j.1440-1754.2010.01992.x

Aim:  Infants born very prematurely often received corticosteroids to minimise the risk of developing bronchopulmonary dysplasia (BPD) but their long term impact on lung function at school age is unclear. Methods:  A cross‐sectional study of 105 children [mean gestation of 27 weeks] was undertaken. Lung function assessments were conducted at a mean age of 10 years according to standard criteria. Corticosteroid dose was obtained from the medical record. Results:  Spirometry in the BPD group was not significantly different to the non‐BPD group, mean per‐cent predicted (95% confidence interval) forced expiratory volume in 1 s (FEV1) 83% (79, 87) versus 86% (83, 90), FEF25%−75% 67% (60, 73) versus 75% (69, 81). Antenatal steroid treatment alone did not adversely affect airflow FEV1, 88% (84.92) versus 90% (82.97), and forced expiratory flow (FEF)25%−75%, 75% (69.81) versus 87% (70.104). Children who received post‐natal corticosteroids had significantly lower flows than those who did not (FEV1 82% (78.85) vs. 88% (85.92), P = 0.006; FEF25%−75% 65% (59.71) vs. 78% (72.84), P = 0.003). Regression analysis revealed days on oxygen and days ventilated were statistically significant but weak predictors of airflow at 10 years of age. Conclusions:  A diagnosis of BPD did not predict reduced spirometry in middle childhood. Children who received post‐natal corticosteroids as preterm infants had reduced expiratory flows compared with those who did not. While post‐natal corticosteroids may be a marker of severity of lung disease, the potential of post‐natal corticosteroids to influence lung development requires further investigation.