Early postnatal corticosteroids in preventing mortality and bronchopulmonary dysplasia: the pivotal importance of selecting an appropriate treated population

This study explores the efficacy of early systematic postnatal corticosteroids (PCS) in reducing bronchopulmonary dysplasia (BPD) and mortality among preterm infants, focusing on identifying the populations most likely to benefit. Although PCS has been extensively studied for its anti-inflammatory effects in preventing BPD, the ideal target population remains unclear. This meta-analysis included 26 randomized controlled trials (RCTs) focusing exclusively on systemic intravenous PCS. Studies were stratified by baseline BPD or mortality rates in control groups (< 50%, 50–65%, and > 65%). Results indicated that PCS effectiveness in reducing BPD or mortality was significantly associated with baseline risk, with rate differences (RD) for BPD or mortality of − 0.03 (95% CI − 0.08, 0.01) in lower-risk groups (< 50%), − 0.07 (95% CI − 0.12, − 0.01) in moderate-risk groups (50–65%), and − 0.18 (95% CI − 0.32, − 0.04) in high-risk groups (> 65%). Linear logistic analysis demonstrated a significant trend, with higher baseline event rates in control groups associated with a more substantial RD (RD ~ rates in controls, R² = 0.228, p = 0.014). Both dexamethasone and hydrocortisone showed similar trends.

Conclusion: These findings underscore that the baseline event rates in the control group are potentially correlated with the efficacy of PCS in preventing BPD or mortality, offering more precise guidance beyond the general “high-risk” category and supporting baseline risk stratification for more targeted PCS therapy in clinical practice.