Optimal postnatal corticosteroid regimens to prevent bronchopulmonary dysplasia with minimal adverse effects

Postnatal corticosteroids can facilitate ventilator weaning and reduce the risk of bronchopulmonary dysplasia (BPD); therefore, they are commonly used to prevent or treat BPD in preterm infants, particularly those born extremely pre term.Despite their frequent use in highrisk infants with severe BPD, no clear guidelines have been established for the optimal timing of administration, dosage, corticoste roid type, route of delivery, and indication based on the infant's baseline risk of BPD.Early systemic corticosteroid administration, particularly dexamethasone within the first week of life, appears to be associated with adverse neurodevelopmental outcomes and is generally not re commended.Dexamethasone and hydrocortisone exhibit dis tinct biological and clinical effects, yet evidence from direct comparative studies is limited.Dexamethasone may improve cerebral palsyfree survival of infants at high risk of BPD but poses potential harm in those at low risk, highlighting the need for individualized riskbased decisionmaking.Optimal dosing remains unclear: lower doses may reduce systemic side effects despite the uncer tainty of their neurodevelopmental safety, whereas high er doses may be more effective in selected highrisk infants.Inhaled corticosteroids have inconclusive benefits compared with systemic therapy.The intratracheal admi nistration of corticosteroids with surfactant improves distal airway delivery and reduces death or BPD rates; however, short and longterm safety data remain limit ed.Overall, postnatal corticosteroids should be used cautiously and selectively in highrisk, ventilatordepen dent infants with severe BPD.Future highquality trials are needed to evaluate longterm survival free of neuro developmental impairments.