O2113: National Survey of Neonatologists on the Use of Postnatal Steroids for the Prevention and Treatment of Bronchopulmonary Dysplasia (BPD)

Background: Bronchopulmonary dysplasia (BPD) remains a significant challenge in neonatal care. Postnatal steroids have benefits in both the prevention and treatment of BPD, but recent trials have challenged this notion. Understanding variations in the use of steroids for BPD in clinical practice is critical for optimizing neonatal outcomes. The last comprehensive survey on this subject in the U.S. was conducted in 2009. Hence, this study aimed to assess the recent practice trends among neonatologists across the United States regarding the use of postnatal steroids for BPD.

Methods: This electronic survey study was conducted from December 2024 to February 2025 among practicing attending neonatologists in the U.S. who were members of the Section on Neonatal-Perinatal Medicine (SoNPM). REDCap was utilized for survey creation, distribution, and analysis (IRB exempt). The survey collected data on institutional characteristics, clinician demographics, and steroid use practices, including indications, frequency, and barriers to use. Responses were analyzed to identify trends in steroid utilization and decision-making criteria.

Results: We received 197 survey responses, out of which 164 respondents completed all required questions. The overall demographics of the respondents are shown in Table 1, with a majority practicing in academic (65.5%), level 4 NICUs (54.3%), and with >10 years' experience (55.8%). There was wide variability in indications, clinical goals, type of steroid, regimen, and timing of use of postnatal steroids for prevention and treatment of BPD, as shown in Table 2. Most respondents use steroids "often" or "sometimes" for both prevention (72.6%) and treatment (77.1%). Dexamethasone was the most used steroid for prevention (86%) and treatment (65.9%), and initiation typically occurred between 15 to 28 days postnatally (61%). Clinical decisions for the use of steroids frequently focused on facilitating extubation (59.1%, "often") and weaning invasive ventilation (54.9%, "often"). Just over half of responders (51.2%) used the NICHD BPD risk calculator to guide their use of steroids for BPD. The majority indicated a shared decision with family before initiating steroids (71.6%), but only half (53.7%) got any consent. Repeated steroid courses were commonly used in both prevention (46.3%) and treatment (67.7%). Sixteen neonatologists reported "never using steroids for BPD", mostly due to the increased risk of neurodevelopmental impairment (43.8%) and "no efficacy in BPD" (25%).

Conclusion: This study highlights the persistent variability in postnatal steroid use for prevention and treatment of BPD among the current U.S. neonatologists. While many clinicians incorporate steroids into their practice and use a risk-stratified approach, concerns about neurodevelopmental outcomes remain a primary deterrent. These findings underscore the need for standardized guidelines and further research to balance the benefits and risks of steroid therapy in neonates at risk for or diagnosed with BPD.