Use of Methylprednisolone Pulses as Rescue Therapy in Neonates with Bronchopulmonary Dysplasia: A 2-year Follow-up

Abstract

Background: Bronchopulmonary dysplasia (BPD) remains a significant morbidity among extremely preterm neonates requiring prolonged respiratory support. Although dexamethasone is commonly used, evidence on methylprednisolone pulse therapy in evolving BPD remains limited. Aim: To describe the clinical outcomes and short-term neurodevelopmental follow-up of preterm neonates with BPD treated with intravenous methylprednisolone pulses in a tertiary neonatal intensive care unit. Methods: This case series included four extremely preterm infants (25–27+6 weeks of gestation) diagnosed with evolving BPD requiring prolonged ventilatory or non-invasive respiratory support. All patients had received prior low-dose dexamethasone (DART regimen) before receiving intravenous methylprednisolone pulses at a dose of 300 mg/m²/day for three consecutive days. Clinical outcomes included successful extubation, duration of respiratory support and survival. Neurodevelopmental assessments were performed using the Hammersmith Neonatal Neurological Examination (HNNE), Prechtl General Movements Assessment, Hammersmith Infant Neurological Examination (HINE), and Bayley Scales of Infant and Toddler Development, Fourth Edition (BSID-IV), at corrected age. Results: All four infants showed improvement in respiratory status following methylprednisolone therapy, with successful weaning from mechanical ventilation or non-invasive ventilation. Three infants survived without significant neurodevelopmental impairment at 2-year follow-up, whereas one infant died at 2.5 years of age due to respiratory infection. BSID-IV scores remained within acceptable developmental ranges across cognitive, language and motor domains in the survivors. Conclusion: Intravenous methylprednisolone pulse therapy may be associated with improved respiratory outcomes in selected preterm infants with severe evolving BPD. However, given the limited sample size, conclusions regarding safety and efficacy remain preliminary and require validation in larger controlled studies.