1421 CORTICOSTEROID RESPONSIVENESS IN CHRONIC LUNG DISEASE OF PREMATURITY

Abstract

Corticosteroids (CS) have been anecdotally reported to improve chronic lung disease (CLD) in premature infants. Concern over equivocal results and long-term CNS effects prompted us to review our clinical experience. Between 01/78 and 11/80 we cared for 16 premature infants with clinical and X-ray diagnosis of CLD, O₂ requirement >30 days and A_aDO₂ >100 who received CS for >48 hrs (mean dose 4.04 ± 1.66 mg/kg/day prednisone equivalent). A positive response to CS was defined as a >30% drop in A_aDO₂ by days 4-6 post introduction of CS which was sustained for >7 days. Eight positive responses in 8 infants and 10 failures to respond in another 8 infants were found. Responders had lower birth-weights (p <0.01), gestational ages (p <0.05) and gained more weight/day prior to CS (p <0.01) as compared to nonresponders and decreased PCO₂ (p <0.05) pre- and post CS. There was no difference between the two groups in mean A_aDO₂, weight at time of treatment, or the dose given, X-ray appearance, postnatal age, mortality and duration of O₂ therapy. Nine infants with CLD who did not receive CS were selected as a control group. Only one had a dramatic but transient decrease in O₂ requirement similar to the defined positive response. In conclusion, 50% of infants receiving CS had a dramatic improvement in their lung function. However, it is unclear whether this treatment altered their long-term outcome. CS responsiveness may be a function of some unrecognized etiologic difference or complication of CLD.

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