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Objectives Postnatal corticosteroid use for severe life-threatening chronic lung disease (CLD) remains controversial.1 2 Balancing potent anti-inflammatory affects to potential adverse effects on the developing brain, worsening neurodevelopmental outcomes and increasing rates of cerebral palsy is difficult.3 4 Birmingham Women's & Children's Hospitals have established of a CLD working group, comprising a tertiary neonatologist, a tertiary respiratory paediatrician and is open to doctors from around the West Midlands to discuss cases of severe life-threatening CLD – defined as infants born 1 2 5 Methods From October 2021 – October 2023 (2 years) we have recorded the details of the babies discussed and analysed details using BadgerNet and local electronic records. A brief narrative of the course of their neonatal journey to date was generated, focusing on intercurrent infection, gastroesophageal reflux disease, significant patent ductus arteriosus (PDA) echocardiography evidence of pulmonary hypertension and growth/nutrition. Of those that went onto receive methylprednisolone we then looked at the short-term outcomes with the aim of achieving progression onto low-flow nasal prong oxygen to enable discharge. Our neonatal intensive care unit (NICU) is located on a physically separate site and therefore babies nearing term needing ongoing medical input need to be discharged to either a local hospital or tertiary children's hospital for ongoing care. Results 62 babies were discussed and 36 met the definition for severe life-threatening CLD. IV Methylprednisolone was given to 12 of these babies after multidisciplinary team discussions. 25% of these babies showed no improvement and died from complications associated with extreme prematurity. 33% were transferred to their local hospital for ongoing discharge planning in nasal prong oxygen. 25% were discharged home from NICU in nasal prong oxygen with follow up from the neonatal community outreach team. The remaining 17% had ongoing need for positive-pressure or high -low oxygen at 44 weeks CGA and additional tertiary paediatric needs relating to their prematurity and were transferred to the children's hospital. Conclusion The commencement of this multidisciplinary service has improved collaborative decision making for those infants with severe life-threatening CLD, relationships between departments and has enhanced NICU awareness of severe CLD. Our statistics have given clinicians accurate local data to counsel parents.5–7 The shared decision making enables individualised planning and management of local babies but has also been utilised to the wider regional neonatal community. Postgraduate doctors-in training have attended for educational purposes and the group has had regular input from 3 of the regional NICUs and at least 3 of the local neonatal units. References Naples R. Archives of Disease in Childhood 2022. Doyle LW. Cochrane Database of Systematic Reviews 2021. Barrington KJ. BMC Paediatrics 2001. Puia-Dumitrescu M. JAMA 2022. Kiddo N. Thorax 2022. Cummings JJ. Paediatrics 2022. Billion E. Pediatric pulmonology 2021.
Djemai et al. (Tue,) studied this question.