The Use of Dexamethasone in Premature Infants at Risk for Bronchopulmonary Dysplasia or Who Already Have Developed Chronic Lung Disease: A Cautionary Note

PEDIATRICS ◽  
1991 ◽  
Vol 88 (2) ◽  
pp. 414-415
Author(s):  
KENNETH L. HARKAVY
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Meta Analysis ◽  
Cautionary Note ◽  
Short Treatment ◽  
Treatment Regimens ◽  
Length Of Treatment ◽  
Term Benefit ◽  
Combined Data

In Reply.— The letter-to-the-editor from Dr Frank is a cautionary note about the risks of glucocorticoid therapy for chronic lung disease in infants. These concerns are real and have been enumerated in most papers on the subject. Only one study to date has suggested a long-term benefit (decreased mortality); yet consistently respiratory therapy support is decreased by steroid use. I have performed a limited meta-analysis because all studies have had similar enrollment criteria and treatment regimens. Two lengths of treatment have been compared and the combined data compared with the controls (Table 1). [See table in the PDF file] This analysis suggests that there is no major difference in outcome by length of treatment, although short treatment was associated with less hyperglycemia and longer duration of intubation. Comparison of all steroid-treated patients with placebo-treated babies showed treated infants had more hyperglycemia (P < .01 χ2) but an average of 11 fewer days of mechanical ventilation (intermittent mandatory ventilation, ImV). (t test was not done due to lack of raw data; however, difference was significant in each subgroup.)

Long-term follow-up of chronic lung disease of infancy

2004 ◽  
Vol 37 (S26) ◽  
pp. 106-107 ◽  
Author(s):  
Teresa Bandeira ◽  
Teresa Nunes
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Long Term Follow Up

scholarly journals Early Changes and Indicators Characterizing Lung Aging in Neonatal Chronic Lung Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Jennifer Sucre ◽  
Lena Haist ◽  
Charlotte E. Bolton ◽  
Anne Hilgendorff
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Health Care Professionals ◽  
Treatment Strategies ◽  
Oxygen Toxicity ◽  
Growth Factor Signaling ◽  
Inflammatory Processes ◽  
Long Term Consequences ◽  
Neonatal Chronic Lung Disease

Infants suffering from neonatal chronic lung disease, i.e., bronchopulmonary dysplasia, are facing long-term consequences determined by individual genetic background, presence of infections, and postnatal treatment strategies such as mechanical ventilation and oxygen toxicity. The adverse effects provoked by these measures include inflammatory processes, oxidative stress, altered growth factor signaling, and remodeling of the extracellular matrix. Both, acute and long-term consequences are determined by the capacity of the immature lung to respond to the challenges outlined above. The subsequent impairment of lung growth translates into an altered trajectory of lung function later in life. Here, knowledge about second and third hit events provoked through environmental insults are of specific importance when advocating lifestyle recommendations to this patient population. A profound exchange between the different health care professionals involved is urgently needed and needs to consider disease origin while future monitoring and treatment strategies are developed.

scholarly journals Individual Patient Data Meta-Analysis of Survival and Psychosomatic Self-Regulation from Published Prospective Controlled Cohort Studies for Long-Term Therapy of Breast Cancer Patients with a Mistletoe Preparation (Iscador)

2010 ◽  
Vol 7 (2) ◽  
pp. 157-166 ◽  
Author(s):  
R. Ziegler ◽  
Ronald Grossarth-Maticek
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Self Regulation ◽  
Breast Cancer Patients ◽  
Data Set ◽  
Randomized Studies ◽  
Combined Data

Mistletoe preparations such as Iscador are in common use as complementary/anthroposophic medications for many cancer indications, particularly for solid cancers. The efficacy is still discussed controversially. This paper presents an individual patient data meta-analysis of all published prospective matched-pair studies with breast cancer patients concerned with long-term application of a complementary/anthroposophic therapy with the mistletoe preparation Iscador. Six sets of data were available for individual patient meta-analysis of breast cancer patients, matched according to prognostic factors into pairs with and without mistletoe (Iscador) therapy. The main outcome measures were overall survival and psychosomatic self-regulation. Overall survival was almost significant in favor of the Iscador group in the combined data set of the randomized studies: estimate of the hazard ratio with 95% confidence interval 0.59 (0.34, 1.02). Overall survival was highly significant in the combined data set of the non-randomized studies: 0.43 (0.34, 0.56). In the combined analysis of the randomized studies, improvement of psychosomatic self-regulation, as a measure of autonomous coping with the disease, was highly significant in favor of the Iscador group: estimate of the median difference 0.45 (0.15, 0.80),P= 0.0051. The analyzed studies show that therapy with Iscador might prolong overall survival and improve psychosomatic self-regulation of breast cancer patients.

scholarly journals Postnatal hydrocortisone treatment for chronic lung disease in the preterm newborn and long-term neurodevelopmental follow-up

2008 ◽  
Vol 93 (1) ◽  
pp. F58-F63 ◽  
Author(s):  
K J Rademaker ◽  
L S de Vries ◽  
C S P M Uiterwaal ◽  
F Groenendaal ◽  
D E Grobbee ◽  
...  
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Preterm Newborn ◽  
Hydrocortisone Treatment

scholarly journals Corticosteroids in infant chronic lung disease

2004 ◽  
Vol 61 (3) ◽  
Author(s):  
C. May ◽  
A. Greenough
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Alternative Therapy ◽  
Neurodevelopmental Outcome ◽  
Health Care Utilisation ◽  
Respiratory Morbidity ◽  
Care Utilisation ◽  
Acute Side Effects ◽  
Postmenstrual Age

Chronic lung disease (CLD), defined as chronic oxygen dependency at 36 weeks postmenstrual age, is increasing and associated with chronic respiratory morbidity and high health care utilisation at follow up. Many strategies, tested in randomised trials, have failed to reduce CLD. In contrast, corticosteroids if given systemically within the first two weeks after birth reduce CLD and may also favourably influence survival. Unfortunately, systemically administered corticosteroids have many acute side-effects and adversely affect long term neurodevelopmental outcome. If given by inhalation, corticosteroids have fewer adverse effects, but are less efficacious. Further research is required to accurately identify infants at highest risk of developing CLD, the corticosteroid dosage associated with a positive risk: benefit ratio and preferably a safer and more effective alternative therapy.

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