{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T01:59:51Z","timestamp":1783216791673,"version":"3.54.6"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:p>\n            Objective\u2003Intercenter variation and trends in postnatal steroids (PNS) use among preterm infants for prevention or treatment of bronchopulmonary dysplasia (BPD) is known. Understanding intracenter PNS use patterns facilitate implementation of center-specific change interventions to optimize outcomes.<\/jats:p><jats:p>This study aimed to (i) quantify the proportion of infants who received PNS, and describe the timing, type, trends over time, regimen used, and deviations, and (2) describe the clinical characteristics and unadjusted outcomes of infants who received PNS.<\/jats:p><jats:p>\n            Study Design\u2003This was a cohort study in a quaternary neonatal intensive care unit including infants born at less than 33 weeks, and who received PNS for prevention or treatment of BPD between 2011 and 2021. Following data were included: proportion of babies who received PNS; type of PNS; age at initiation and duration; trends over time; deviation from published regimen; morbidity, mortality, and cointerventions.<\/jats:p><jats:p>\n            Results\u2003One hundred and eighty four infants (8% of &lt;33 week' infants) received PNS. The median (interquartile range [IQR]) gestational age and birth weight were 25 (24\u201326) weeks and 720 (625\u2013841) grams, respectively. The median (IQR) day of initiation and duration of PNS use were 29 (19\u201338) and 10 (10\u201322) days, respectively. One hundred and fifty-seven (85%) infants received dexamethasone (DX) and 22 (12%) received hydrocortisone as the first PNS course, and 71 (39%) infants received multiple courses. The proportion of infants receiving PNS remained unchanged, but the cumulative median dose received for BPD per patient increased by 56%. Nearly one-third of cumulative PNS dose came from PNS used for non-BPD indications. Forty-six percent infants had a deviation from published regimen (\u00b120% deviation in duration or \u00b110% deviation in dose). Survival, survival without major morbidity, moderate-to-severe BPD, and technology dependence at discharge were 87, 2, 91, and 67%, respectively.<\/jats:p><jats:p>\n            Conclusion\u2003Increased variation in PNS use, deviation from published regimen, and concurrent PNS exposure from non-BPD indication offer insights into implementing interventions to improve processes.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-2267-4363","type":"journal-article","created":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T00:29:25Z","timestamp":1707870565000},"page":"1858-1866","source":"Crossref","is-referenced-by-count":5,"title":["Postnatal Steroids Use for Bronchopulmonary Dysplasia in a Quaternary Care NICU"],"prefix":"10.1055","volume":"41","author":[{"given":"Uthayakumaran","family":"Kanagaraj","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Neonatal Division, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Neonatal Division, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amuchou","family":"Soraisham","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Neonatal Division, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhay","family":"Lodha","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Neonatal Division, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakesh","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Neonatal Division, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tapas","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Neonatal Division, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5323-1900","authenticated-orcid":false,"given":"Sandesh","family":"Shivananda","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Neonatal Division, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,3,4]]},"reference":[{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1007\/s12519-023-00708-8","article-title":"Systemic postnatal corticosteroid use for the prevention of bronchopulmonary dysplasia and its relationship to early neurodevelopment in extremely preterm infants","volume":"19","author":"E Esterman","year":"2023","journal-title":"World J Pediatr"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1016\/j.jpeds.2005.01.047","article-title":"Extremely low birthweight neonates with protracted ventilation: mortality and 18-month neurodevelopmental outcomes","volume":"146","author":"M C Walsh","year":"2005","journal-title":"J Pediatr"},{"issue":"11","key":"ref4","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1001\/archpedi.161.11.1082","article-title":"Developmental sequelae in preterm infants having a diagnosis of bronchopulmonary dysplasia: analysis using a severity-based classification system","volume":"161","author":"E J Short","year":"2007","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"e359","DOI":"10.1542\/peds.112.5.e359","article-title":"Cognitive and academic consequences of bronchopulmonary dysplasia and very low birth weight: 8-year-old outcomes","volume":"112","author":"E J Short","year":"2003","journal-title":"Pediatrics"},{"issue":"03","key":"ref6","first-page":"57","article-title":"Economic costs associated with mental retardation, cerebral palsy, hearing loss, and vision impairment\u2013United States, 2003","volume":"53","author":"Centers for Disease Control and Prevention (CDC)","year":"2004","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1542\/peds.2004-2843","article-title":"Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: a multicenter, international, randomized, controlled trial","volume":"117","author":"L W Doyle","year":"2006","journal-title":"Pediatrics"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1016\/S0140-6736(16)00202-6","article-title":"Effect of early low-dose hydrocortisone on survival without bronchopulmonary dysplasia in extremely preterm infants (PREMILOC): a double-blind, placebo-controlled, multicentre, randomised trial","volume":"387","author":"O Baud","year":"2016","journal-title":"Lancet"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1001\/jama.2018.21443","article-title":"Effect of hydrocortisone therapy initiated 7 to 14 days after birth on mortality or bronchopulmonary dysplasia among very preterm infants receiving mechanical ventilation: a randomized clinical trial","volume":"321","author":"W Onland","year":"2019","journal-title":"JAMA"},{"issue":"07","key":"ref10","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1111\/j.1651-2227.2003.tb02541.x","article-title":"Short- and long-term effects of neonatal glucocorticoid therapy: is hydrocortisone an alternative to dexamethasone?","volume":"92","author":"M van der Heide-Jalving","year":"2003","journal-title":"Acta Paediatr"},{"issue":"14","key":"ref11","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1055\/s-0039-1694004","article-title":"Retrospective analysis of short-term respiratory outcomes of three different steroids used in clinical practice in intubated preterm infants","volume":"37","author":"S Nath","year":"2020","journal-title":"Am J Perinatol"},{"issue":"11","key":"ref12","doi-asserted-by":"crossref","first-page":"e063835","DOI":"10.1136\/bmjopen-2022-063835","article-title":"Postnatal corticosteroid use for prevention or treatment of bronchopulmonary dysplasia in England and Wales 2012-2019: a retrospective population cohort study","volume":"12","author":"S Yao","year":"2022","journal-title":"BMJ Open"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"e2022057530","DOI":"10.1542\/peds.2022-057530","article-title":"Postnatal corticosteroids to prevent or treat chronic lung disease following preterm birth","volume":"149","author":"J J Cummings","year":"2022","journal-title":"Pediatrics"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1093\/pch\/pxaa073","article-title":"Postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia in preterm infants","volume":"25","author":"B Lemyre","year":"2020","journal-title":"Paediatr Child Health"},{"issue":"03","key":"ref15","first-page":"CD010941","article-title":"Systemic corticosteroid regimens for prevention of bronchopulmonary dysplasia in preterm infants","volume":"3","author":"W Onland","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1159\/000499361","article-title":"European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update","volume":"115","author":"D G Sweet","year":"2019","journal-title":"Neonatology"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"e206826","DOI":"10.1001\/jamapediatrics.2020.6826","article-title":"Assessment of postnatal corticosteroids for the prevention of bronchopulmonary dysplasia in preterm neonates: a systematic review and network meta-analysis","volume":"175","author":"V V Ramaswamy","year":"2021","journal-title":"JAMA Pediatr"},{"issue":"02","key":"ref18","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1542\/peds.109.2.330","article-title":"Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants","volume":"109","author":"Committee on Fetus and Newborn","year":"2002","journal-title":"Pediatrics"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1159\/000530128","article-title":"Trends, characteristic, and outcomes of preterm infants who received postnatal corticosteroid: a cohort study from 7 high-income countries","volume":"120","author":"S Parikh","year":"2023","journal-title":"Neonatology"},{"issue":"04","key":"ref20","doi-asserted-by":"crossref","first-page":"2300825","DOI":"10.1183\/13993003.00825-2023","article-title":"Impact of postnatal dexamethasone timing on preterm mortality and bronchopulmonary dysplasia: a propensity score analysis","volume":"62","author":"T C Kwok","year":"2023","journal-title":"Eur Respir J"},{"issue":"08","key":"ref22","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1038\/s41372-021-01083-w","article-title":"Postnatal steroid management in preterm infants with evolving bronchopulmonary dysplasia","volume":"41","author":"Z T Htun","year":"2021","journal-title":"J Perinatol"},{"key":"ref23","volume-title":"The Health Care Data Guide. 2nd ed","author":"L Provost","year":"2022"},{"issue":"05","key":"ref24","doi-asserted-by":"crossref","first-page":"e103","DOI":"10.1097\/pq9.0000000000000103","article-title":"The Aggregate Point Rule for identifying shifts on P charts and U charts","volume":"3","author":"T A Wheeler","year":"2018","journal-title":"Pediatr Qual Saf"},{"issue":"10","key":"ref25","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1038\/s41372-023-01692-7","article-title":"Preterm lung and brain responses to mechanical ventilation and corticosteroids","volume":"43","author":"N H Hillman","year":"2023","journal-title":"J Perinatol"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1093\/oso\/9780198794837.003.0016","volume-title":"Unwarranted variations in healthcare utilization","author":"J A Olsen","year":"2017"},{"issue":"04","key":"ref27","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1038\/s41372-020-00862-1","article-title":"Using quality improvement to implement consensus guidelines for postnatal steroid treatment of preterm infants with developing bronchopulmonary dysplasia","volume":"41","author":"T P Hansen","year":"2021","journal-title":"J Perinatol"},{"issue":"12","key":"ref28","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1056\/NEJMoa2114897","article-title":"Hydrocortisone to improve survival without bronchopulmonary dysplasia","volume":"386","author":"K L Watterberg","year":"2022","journal-title":"N Engl J Med"},{"issue":"08","key":"ref29","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1007\/s00431-019-03398-5","article-title":"Efficacy and safety of systemic hydrocortisone for the prevention of bronchopulmonary dysplasia in preterm infants: a systematic review and meta-analysis","volume":"178","author":"I P Morris","year":"2019","journal-title":"Eur J Pediatr"},{"issue":"06","key":"ref30","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1136\/archdischild-2021-323573","article-title":"Online clinical tool to estimate risk of bronchopulmonary dysplasia in extremely preterm infants","volume":"107","author":"R G Greenberg","year":"2022","journal-title":"Arch Dis Child Fetal Neonatal Ed"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2267-4363.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T14:56:46Z","timestamp":1730818606000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2267-4363"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,13]]},"references-count":28,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2024,9,11]]},"published-print":{"date-parts":[[2024,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2267-4363","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,2,13]]},"published":{"date-parts":[[2024,2,13]]}}}