Introduction: Corticosteroids have been used in preterm infants with immature lungs to decrease their need for supplemental oxygen and mechanical ventilation. Whether the benefits of the treatment outweigh possible adverse effects remains controversial. The main objective of the study was to evaluate the effects of intravenous and inhalation corticosteroids on preterm infants' need for supplemental oxygen and mechanical ventilation and potential adverse effects.

Material and methods: This was a retrospective cohort study on preterm infants at the Neonatal Intensive Care Unit of Children's Hospital Iceland, born between 2000-2014 and treated with intravenous (n=28) or inhalation (n=30) corticosteroids for immature lung disease. For each infant receiving steriods one infant who did not receive steriods was selected as control, matched on gestational age.

Results: There was a significant decrease in the need for supplemental oxygen following intravenous and inhalation corticosteroids administration, and a significant decrease in the need for mechanical ventilation following intravenous corticosteroids administration, but not in controls. Infants receiving intravenous corticosteroids gained significantly less weight than controls during treatment, but no significant difference in weight between groups was found at 35 weeks postmenstrual age, or in other possible adverse effects such as the prevalence of cerebral palsy.

Conclusion: Intravenous and inhalation corticosteroids decrease the need for supplemental oxygen in preterm infants with immature lung disease and intravenous steriods facilitate earlier weaning from mechanical ventilation, without significant adverse effects. Therefore, it seems justifiable in selected cases to use corticosteroids in treatment of preterm infants with severe immature lung disease.

Figures and tables:

Figure 1. Distribution of the infants between groups. 

Figure 2. Need for supplemental oxygen among infants who were treated with intravenous corticosteroids and controls. 

Need for supplemental oxygen from 5 days before treatment and until 14 days after the beginning of treatment. Day 0 is the first day of treatment.

- Comparison of need for supplemental oxygen within the treatment group: Day -5 and 0, p<0.001; day 0 and 1, p=0.01; day 1 and 2, p<0.001; day 2 and 3, p=0.01; day 7 and 14, p=0.03; the change between other consecutive days was non-significant.

- Comparison of need for supplemental oxygen between treatment and control groups: Day -5, p<0.01; day 0, p<0.001; day 1, p=0.001; the need for supplemental oxygen on other days was non-significant.

Figure 3. Comparison of the number of infants receiving mechanical ventilation between the treatment group and controls.

Number of infants receiving mechanical ventilation from 5 days before treatment and until 14 days after the beginning of treatment. Day 0 is the first day of treatment.

- The number of infants receiving mechanical ventilation between infants in the treatment group on day 0 and day 4 was significant, p=0.03.

- Comparison of the number of infants on mechanical ventilation between treatment and control groups: Day -5, p<0.01; day 0, p<0.001; day 1, p<0.001; day 2, p<0.001; day 3, p=0.01; after day 3 there was not a significant difference between groups.

Figure 4. Comparison of the need for supplemental oxygen between infants who were treated with inhalation corticosteroids and controls. 

The need for supplemental oxygen from 5 days before treatment and until 14 days after the beginning of treatment. Day 0 is the first day of treatment.
- Comparison of need for supplemental oxygen within treatment group: Day 0 and day 3, p<0.01. Comparison of need for supplemental oxygen between treatment and control groups: Day -5, p<0.001; day 0, p<0.001; day 1, p<0.001; day 2, p<0.001; day 3, p<0.01; day 4, p=0.03; day 5, p=0.01; day 6, p=0.01; day 7, p=0.02; day 10, p=0.02; day 14, p=0.3.

Table 1. Main clinical characteristics of  the treatment and control groups.

Table 2. Comparison of possible adverse effects of intravenous corticosteroids between treatment and control groups