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Preterm lung and brain responses to mechanical ventilation and corticosteroids

Journal of Perinatology volume 43, pages 1222–1229 (2023)Cite this article

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Abstract

Mechanical ventilation is necessary to maintain oxygenation and ventilation in many preterm infants. Unfortunately, even short periods of mechanical ventilation can cause lung and airway injury, and initiate the lung inflammation that contributes to the development of bronchopulmonary dysplasia (BPD). The mechanical stretch leads to airway cell differentiation and simplification of the alveoli, and releases cytokines that cause systemic response in other organs. Mechanical ventilation also leads to brain injury (IVH, white and gray matter) and neuronal inflammation that can affect the neurodevelopment of preterm infants. In efforts to decrease BPD, corticosteroids have been used for both prevention and treatment of lung inflammation. Corticosteroids have also been demonstrated to cause neuronal injury, so the clinician must balance the negative effects of both mechanical ventilation and steroids on the brain and lungs. Predictive models for BPD can help assess the infants who will benefit most from corticosteroid exposure. This review describes the lung and brain injury from mechanical ventilation in the delivery room and chronic mechanical ventilation in animal models. It provides updates on the current guidelines for use of postnatal corticosteroids (dexamethasone, hydrocortisone, budesonide, budesonide with surfactant) for the prevention and treatment of BPD, and the effects the timing of each steroid regimen has on neurodevelopment.

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Fig. 1: Effects of mechanical ventilation on lung and brain in preterm animals.

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Funding

This work was supported by NIH grants R21- HD100721-01 (NHH).

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Authors and Affiliations

  1. Division of Neonatology, SSM Health Cardinal Glennon Children’s Hospital, Saint Louis University, Saint Louis, MO, 63104, USA

    Noah H. Hillman

  2. Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, 45229, USA

    Alan H. Jobe

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  1. Noah H. Hillman
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NHH drafted, revised, and approved the manuscript. AJH revised and approved the manuscript.

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Correspondence to Noah H. Hillman.

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Hillman, N.H., Jobe, A.H. Preterm lung and brain responses to mechanical ventilation and corticosteroids. J Perinatol 43, 1222–1229 (2023). https://doi.org/10.1038/s41372-023-01692-7

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  • DOI: https://doi.org/10.1038/s41372-023-01692-7

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