Shinwell E S, Lerner-Geva L, Lusky A, Reichman B
Department of Neonatology, Kaplan Medical Center, Rehovot, Hadassah Medical School, Hebrew University, Jerusalem, Israel. eric_
Arch Dis Child Fetal Neonatal Ed. 2007 Jan;92(1):F30-3. doi: 10.1136/adc.2006.094474. Epub 2006 Jun 12.
To study the association between reduced use of postnatal steroids for bronchopulmonary dysplasia (BPD) in very low birthweight (VLBW) infants and oxygen (O(2))-dependency at 28 days of age and at 36 weeks postmenstrual age.
Large national database study.
The Israel National VLBW Neonatal Database.
The sample included infants born between 1997 and 2004, of gestational age 24-32 weeks, who required mechanical ventilation or O(2) therapy. Four time periods were compared: 1997-8 (era 1, peak use), 1999-2000 (era 2, intermediate), 2001-2 (era 3, expected reduction) and 2003-4 (era 4, lowest). The outcome variable "oxygen dependency" was based on clinical criteria. Multivariate regression models were used to account for confounding variables.
Steroid use fell significantly from 23.5% in 1997-8 to 11% in 2003-4 (p<0.005). After adjustment for relevant confounding variables, the odds ratio for O(2) therapy at 28 days in era 4 versus era 1 was 1.75, 95% confidence interval (CI) 1.47 to 2.09 and 1.41, 95% CI 1.15 to 1.73 at 36 weeks postmenstrual age. The mean duration of O(2) therapy increased from 25.3 days (95% CI 23.3 to 26.3) in era 1, to 28.0 days (95% CI 26.6 to 29.4) in era 4. Survival increased from 78.5% in era 1 to 81.6% in era 4 (p<0.005).
The use of steroids has fallen considerably since the awareness of the adverse effects of this treatment. This change has been temporally associated with increased O(2) dependency at 28 days of age and at 36 weeks postmenstrual age. The prolongation of O(2) therapy was modest in degree.
研究极低出生体重（VLBW）婴儿支气管肺发育不良（BPD）产后类固醇使用减少与28日龄及月经后36周时对氧（O₂）依赖之间的关联。
大型国家数据库研究。
以色列国家极低出生体重新生儿数据库。
样本包括1997年至2004年间出生、胎龄24 - 32周、需要机械通气或O₂治疗的婴儿。比较了四个时间段：1997 - 1998年（时期1，使用高峰）、1999 - 2000年（时期2，中等）、2001 - 2002年（时期3，预期减少）和2003 - 2004年（时期4，最低）。结局变量“氧依赖”基于临床标准。使用多变量回归模型来考虑混杂变量。
类固醇使用从1997 - 1998年的23.5%显著降至2003 - 2004年的11%（p<0.005）。在对相关混杂变量进行调整后，时期4与时期1相比，28日龄时接受O₂治疗的比值比为1.75，95%置信区间（CI）为1.47至2.09；月经后36周时为1.41，95%CI为1.15至1.73。O₂治疗的平均持续时间从时期1的25.3天（95%CI 23.3至26.3）增加到时期4的28.0天（95%CI 26.6至29.4）。存活率从时期1的78.5%增加到时期4的81.6%（p<0.005）。
自认识到这种治疗的不良反应以来，类固醇的使用已大幅下降。这一变化在时间上与28日龄及月经后36周时氧依赖增加相关。O₂治疗延长的程度较小。
