Article type
Year
Abstract
Background: The Committee on Fetus and Newborn of the American Academy of Paediatrics (AAP) and the Fetus and Newborn Committee of the Canadian Paediatric Society (CPS) developed guidelines on the use of postnatal treatment with corticosteroids to prevent or treat bronchopulmonary dysplasia (BPD) in preterm/low birth weight neonates which were published in January 2002 [1]. The statement was based on a synopsis of 5 Cochrane reviews and 7 systematic reviews published in paper journals. In addition results from recent trials not included in the reviews were included. The recommendation was: "The routine use of systemic dexamethasone for the prevention or treatment of chronic lung disease in infants with very low birth weight is not recommended".
Objective: To ascertain whether systematic reviews/Cochrane reviews and/or a practice guideline have changed neonatal practice.
Methods: A literature search (PubMed) was conducted 2004 03 26 and identified one study from Israel [2]. Data from the entire Vermont-Oxford database for the years 1998 - 2002 were included as were data from one neonatal unit in Canada (Mount Sinai Hospital, Toronto) [3].
Results: The study from Israel referred to the AAP/CPS statement, 4 Cochrane reviews and 4 other systematic reviews. The authors noted a reduction in the use of postnatal corticosteroids from 22% in 1993-94 to 6% in 2001 (data from 18 neonatal units in Israel). There was no statistically significant increase in the diagnosis of BPD at 36 weeks (13% and 17% respectively). At Mount Sinai hospital there was a reduction in the use of postnatal corticosteroids in infants with a birth weight < 1500 grams from 21% in 1998 to 4% in 2002. There was no significant increase in BPD at 36 weeks (24% in 1998; 25% in 2002). In the entire Vermont Oxford database (including data from different countries) the use of steroids was reduced from 28% in 1998 (total population < 1500 g, N = 23533) to 12% in 2002 (N = 32,339)(p < 0.0001. The need for oxygen at 36 weeks increased from 31 to 39% (p < 0.0001).
Conclusions: There has been a marked reduction in the use of postnatal steroids for the prevention of BPD. There was a temporary association between the publication of trials/systematic reviews/Cochrane reviews and a practice guideline on the topic and the reduction in the use of corticosteroids.
References: 1. Van Aerde J, Shah V, Stark A, Ohlsson; The Committee on Fetus and Newborn of the AAP and the Fetus and Newborn Committee of the Canadian Paediatric Society. Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants. (Joint publication)Pediatr Child Health 2002;7(1):20-28 and Pediatrics 2002;109:330-8. 2. Shinwell ES, Karplus M, Bader D et al., Neonatologists are using much less dexamethasone. Arch Dis Child Fetal Neonatal Ed. 2003;88:F432-3. 3. Vermont Oxford Network 1998 and 2002 Annual Database Summary. Horbar JD, Carpenter JH, editors. Vermont Oxford Network. Burlington, Vermont; 2003.
Objective: To ascertain whether systematic reviews/Cochrane reviews and/or a practice guideline have changed neonatal practice.
Methods: A literature search (PubMed) was conducted 2004 03 26 and identified one study from Israel [2]. Data from the entire Vermont-Oxford database for the years 1998 - 2002 were included as were data from one neonatal unit in Canada (Mount Sinai Hospital, Toronto) [3].
Results: The study from Israel referred to the AAP/CPS statement, 4 Cochrane reviews and 4 other systematic reviews. The authors noted a reduction in the use of postnatal corticosteroids from 22% in 1993-94 to 6% in 2001 (data from 18 neonatal units in Israel). There was no statistically significant increase in the diagnosis of BPD at 36 weeks (13% and 17% respectively). At Mount Sinai hospital there was a reduction in the use of postnatal corticosteroids in infants with a birth weight < 1500 grams from 21% in 1998 to 4% in 2002. There was no significant increase in BPD at 36 weeks (24% in 1998; 25% in 2002). In the entire Vermont Oxford database (including data from different countries) the use of steroids was reduced from 28% in 1998 (total population < 1500 g, N = 23533) to 12% in 2002 (N = 32,339)(p < 0.0001. The need for oxygen at 36 weeks increased from 31 to 39% (p < 0.0001).
Conclusions: There has been a marked reduction in the use of postnatal steroids for the prevention of BPD. There was a temporary association between the publication of trials/systematic reviews/Cochrane reviews and a practice guideline on the topic and the reduction in the use of corticosteroids.
References: 1. Van Aerde J, Shah V, Stark A, Ohlsson; The Committee on Fetus and Newborn of the AAP and the Fetus and Newborn Committee of the Canadian Paediatric Society. Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants. (Joint publication)Pediatr Child Health 2002;7(1):20-28 and Pediatrics 2002;109:330-8. 2. Shinwell ES, Karplus M, Bader D et al., Neonatologists are using much less dexamethasone. Arch Dis Child Fetal Neonatal Ed. 2003;88:F432-3. 3. Vermont Oxford Network 1998 and 2002 Annual Database Summary. Horbar JD, Carpenter JH, editors. Vermont Oxford Network. Burlington, Vermont; 2003.