Factors associated with short-term response after systemic corticosteroid treatment in invasively ventilated preterm infants

PURPOSE: This study evaluated the factors affecting the short-term efficacy of systemic corticosteroid (CS) therapy, focusing on pulmonary hypertension (PH) and other clinical conditions in preterm infants with evolving or established bronchopulmonary dysplasia (BPD). METHODS: A retrospective review was conducted on preterm infants (< 32 weeks of gestation and/or < 1,500 g birth weight) who received systemic CS therapy for BPD. Responders were defined as infants who were extubated within 14 days and/or achieved a ≥ 60% reduction in the respiratory severity score (RSS). RESULTS: Of the 62 infants, 32 were classified as responders and 30 as non-responders. Non-responders had a significantly higher prevalence of PH requiring treatment (70.0% vs. 21.9%, p < 0.001) and hemodynamically significant patent ductus arteriosus (hsPDA) at treatment initiation (30.0% vs. 3.1%, p = 0.005). Responders showed a greater reduction in RSS from day 1 to day 4 (33.8% vs. 11.7%, p = 0.002). In multivariate analysis, PH requiring treatment (adjusted odds ratio [aOR]: 6.66, 95% confidence interval [CI]: 1.39-31.92, p = 0.018) and hsPDA (aOR: 12.54, 95% CI: 1.16-135.05, p = 0.037) at treatment initiation were significant predictors of non-response. CONCLUSION: Identifying the vascular phenotypes of BPD, including PH and hsPDA, before initiating systemic CS therapy may improve patient selection and optimize treatment outcomes. Incorporating early changes in RSS from treatment day 1 to day 4 enhanced the predictive accuracy for treatment failure and may facilitate the timely identification of non-responders.