LAUSR

OBJECTIVE To determine inhaled corticosteroid (IC) use in infants with bronchopulmonary dysplasia (BPD), define the inter-hospital variation of IC administration to infants with BPD, and compare clinical, demographic, and hospital factors associated with IC use. STUDY DESIGN Using the Pediatric Health Information System database a retrospective multicenter cohort of 4,551 infants born at <32 weeks of gestation with developing BPD was studied. The clinical, demographic, and hospital characteristics of infants exposed and not exposed to ICs were compared. RESULTS IC use varied markedly between hospitals, ranging from 0-66% of infants with BPD exposed to ICs. Increased annual BPD census was not associated with IC use. Twenty-five percent (1,144/4,551) of patients with BPD and 43% (536/1,244) of those with severe BPD received ICs. Increased IC exposure was associated with lower birth weight and gestational age, days on respiratory support, need for positive pressure ventilation at 36 weeks post-menstrual age, need for tracheostomy, and increased use of systemic steroids, bronchodilators, and diuretics. CONCLUSION IC exposure is common in infants with BPD, with substantial inter-hospital variability. IC use was associated with more severe disease. Hospital experience did not account for the wide variability in IC use by hospital. Further research into the effects of IC use are urgently needed to help guide their use in this vulnerable population.