Infants with CLD have reactive airways, frequent ER visits and hospitalizations, difficulty
with RSV and other respiratory infections. They also have impaired growth due to
increased caloric needs and may need to be on increased calorie formulas. Since lung
parenchyma continues to grow until age eight, symptoms usually abate with time.
Corticosteroid use in infants for CLD
In premature infants, corticosteroid therapy is very controversial, long-term follow-up
studies from the initial groups that received post-natal therapy have revealed significant
risks for neurodevelopmental delay. The risks seem to be associated with length of
course and bulk dose exposure. NO STEROID REGIMEN HAS PREVENTED CLD.
Current practice is to resort to steroids in order to attenuate the inflammation related to
(CLD) when demands of mechanical ventilation for the infant threaten long-term
outcomes. Another indication for corticosteroid therapy is to supplement the
corticosteroid insufficient infant.
Dexamethasone (Decadron) dose ranges from 0.05-0.5 mg/kg/day IV (more
commonly, 0.25 mg/kg/dose q12hrs for 3 days is used). Courses have currently
trended to 3 day bursts with a steroid-free period between bursts. Dexamethasone also
has a very long half-life in the premature infant.