Dear CPQCC Member:
Post-natal steroids for the treatment of chronic lung disease, and more recently for the treatment of hypotension, has been one of the hotly debated areas of neonatal practice for the last 20 years. They have profound effects on pulmonary and cardiovascular status, multiple acute side effects, and the potential to have serious adverse effects on long-term outcome. They have been widely studied, and new data continues to emerge on their use.
The California Perinatal Quality Care Collaborative (CPQCC) is pleased to announce the release of the 2009 Revision of the Postnatal Steroid (PNS) Toolkit. This updated toolkit contains a brief review of the literature on use of PNS in infants, and an outline for how to use this literature and your NICUs CPQCC/VON data for Quality Improvement. This toolkit, like all of the CPQCC toolkits can be accessed at no cost from the CPQCC website at www.cpqcc.org.
Please feel free to share these materials, and the link to the CPQCC website, with the appropriate individuals in your organization, or to other institutions.
Paul Sharek MD
Chair, Perinatal Quality Improvement Panel (PQIP), CPQCC
Summary of changes from Postnatal Steroid Administration Toolkit 2003
The bulk of the 2003 version of the PNS Toolkit dealt with the use of dexamethasone for the prevention and/or treatment of CLD. We have updated this version to include the results of recent trials and meta-analysis of both dexamethasone and hydrocortisone for the prevention and/or treatment of CLD. In keeping with the Cochrane Review approach, we have revised the description of PNS use into two groups: (1) patients who are < 8 days, and (2) patients who are > 7 days old at the initiation of treatment. In view of the exhaustive detail of the recent Cochrane Reviews, we have relied heavily on their findings, and have correspondingly simplified the bibliography.
We have also added brief new sections on the use of inhaled steroids for the treatment of CLD, and on the use of hydrocortisone for the prevention and/or treatment of hypotension associated with adrenal insufficiency. These sections also incorporate data from the recent Cochrane reviews.
We have added two new brief summary statements of Best Practices, regarding used of steroids for CLD and hypotension.
Finally, the discussion of options for benchmarking PNS use, and for developing a PNS QI project have been updated.