Clinical Outcomes of Systemic Steroid Use in Children Under 2 with Bronchiolitis and BPD
In brief
Systemic steroids extend hospital stay by roughly half a day in BPD infants
In a national database of 1,239 children under two with bronchopulmonary dysplasia hospitalized for bronchiolitis, 35% received systemic steroids. Steroid treatment was linked to a longer length of stay (about 0.6 day more) and more days on oxygen, without clear benefit on other outcomes. The finding highlights wide practice variation and the need for prospective trials to define steroid role.
- Journal
- Hospital pediatrics (Q1)
- Published
- 17 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Naseem Alammar, Matt Hall, Vishal Kapadia, Jenny Bohorquez, Vineeta Mittal
- PMID
- 42749298
- DOI
- 10.1542/hpeds.2025-008721
Why clinicians should know about it
- Picked for Pediatrics and Child Health (paper of the day, 21 September 2026): Systemic steroid use in bronchiolitis with BPD
Abstract
OBJECTIVES: No guidelines exist for managing children with bronchopulmonary dysplasia (BPD) hospitalized with acute bronchiolitis. This study evaluated clinical practice and outcomes associated with systemic steroid use in children with BPD and acute bronchiolitis. We hypothesized there would be significant practice variation and improvement in outcomes with steroid use. METHODS: A retrospective study was conducted using the PHIS (Pediatric Health Information System) database. Children aged younger than 2 years with BPD hospitalized from 2012 to 2023 were included. Primary outcomes were systemic steroid use, factors associated with use, and temporal trends. Secondary outcomes were length of stay (LOS), readmissions, intensive care unit use, maximum respiratory support, duration on oxygen, and mortality. Systemic steroid use vs no systemic steroid use groups were compared. RESULTS: Of the 1239 children, 35% received systemic steroids. Steroid use varied from 0% to 75% across hospitals. Hospital-level variation was unrelated to case volume (P = .83). Systemic steroid use was significantly associated with older age, home inhaled corticosteroid (ICS), and in-hospital bronchodilator use, but not with gestational age, birth weight, or BPD severity. Systemic steroid use was significantly associated with longer LOS (2.8 vs 2.2 days, P < .001) and more time on oxygen (2.8 vs 2.3 days, P = .008). CONCLUSION: A total of 35% of hospitalized children with BPD and bronchiolitis received systemic steroids with significant variation in use. Systemic steroid use was associated with older age, home ICS use, longer LOS, and more time on oxygen. Further studies are needed to understand the clinical implications of these associations.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.