The use of dexamethasone in the first week post-birth to prevent BPD is not recommended

The use of dexamethasone in the first week post-birth to prevent BPD is not recommended. (A)

☆Clinicians may consider prescribing a course of low-dose hydrocortisone: (B) ♦️physiologic replacement dose:

◇ 1 mg/kg per day x 7 days,

◇ then 0.5 mg/kg per day x 3 days.

◇ beginning in the first 24 to 48 h after birth, for 10 days, to infants at the highest risk for BPD.

♦️Infants at risk include:

◇ <28 weeks GA or exposed to chorioamnionitis).

🚩There may be an increased risk for late-onset sepsis associated with this practice.

🚩Hydrocortisone should not be combined with indomethacin prophylaxis.

☆The routine use of inhaled corticosteroids to prevent BPD is not recommended. (A)

☆The routine use of dexamethasone after the first week of life for evolving BPD is not recommended. (A)

☆For infants who remain ventilated after the first week post-birth with increasing oxygen requirements and worsening lung disease, the benefits of dexamethasone therapy appear to outweigh the potential adverse effects.

♦️In these circumstances, low-dose dexamethasone:

◇ with an initial dose of 0.15 mg/kg/day to 0.2 mg/ kg/day, tapered over a short course [7 to 10 days] should be considered. ©

☆Hydrocortisone to treat infants with evolving BPD beyond the first week post-birth, or infants with prolonged ventilator dependence, is not recommended. (B)

☆Use of inhaled corticosteroids to treat BPD is not recommended. (B)

More research is needed to identify the most at-risk population and on the utility of alternative corticosteroid preparations and regimens. (A)

(Ref. Canadian pediatric Society, Postnatal corticosteroids to prevent or treat BPD in preterm infants.)