Helsinki University Central Hospital, Hospital for Children and Adolescents, 11 Stenbäck St, PO Box 281, 00029 HUS Helsinki, Finland.
Pediatrics. 2010 Jan;125(1):e1-8. doi: 10.1542/peds.2009-0395. Epub 2009 Dec 14.
Several studies have evaluated dexamethasone for prevention of hearing loss in childhood bacterial meningitis, but results have varied. We compared dexamethasone and/or glycerol recipients with placebo recipients, and measured hearing at 3 threshold levels.
Children aged 2 months to 16 years with meningitis were treated with ceftriaxone but were double-blindly randomly assigned to receive adjuvant dexamethasone intravenously, glycerol orally, both agents, or neither agent. We used the Glasgow coma scale to grade the presenting status. The end points were the better ear's ability to detect sounds of >40 dB, >or=60 dB, and >or=80 dB, with these thresholds indicating any, moderate-to-severe, or severe impairment, respectively. All tests were interpreted by an external audiologist. Influence of covariates in the treatment groups was examined by binary logistic regression.
Of the 383 children, mostly with meningitis caused by Haemophilus influenzae type b or Streptococcus pneumoniae, 101 received dexamethasone, 95 received dexamethasone and glycerol, 92 received glycerol, and 95 received placebo. Only the presenting condition and young age predicted impairment independently through all threshold levels. Each lowering point in the Glasgow scale increased the risk by 15% to 21% (odds ratio: 1.20, 1.21, and 1.15 [95% confidence interval: 1.06-1.35, 1.07-1.37, and 1.01-1.31]; P = .005, .003, and .039) for any, moderate-to-severe, or severe impairment, respectively. Each increasing month of age decreased the risk by 2% to 6% (P = .0001, .0007, and .041, respectively). Neither dexamethasone nor glycerol prevented hearing loss at these levels regardless of the causative agent or timing of antimicrobial agent.
With bacterial meningitis, the child's presenting status and young age are the most important predictors of hearing impairment. Little relief is obtained from current adjuvant medications.
有几项研究评估了地塞米松预防儿童细菌性脑膜炎所致听力损失的效果，但结果不一。我们比较了地塞米松和（或）甘油的使用者与安慰剂使用者，并测量了 3 个阈值水平的听力。
2 个月至 16 岁的细菌性脑膜炎患儿接受头孢曲松治疗，但采用双盲随机方式接受辅助性地塞米松静脉注射、甘油口服、二者联合或均不使用。我们采用格拉斯哥昏迷量表来评估患儿的就诊状态。终点为较好耳探测 >40dB、>＝60dB 和 >＝80dB 声音的能力，这些阈值分别表示存在听力损失、中重度至重度听力损失和重度听力损失。所有测试均由外部听力学家进行解读。采用二项逻辑回归法检验治疗组中协变量的影响。
在 383 例患儿中，大多数由乙型流感嗜血杆菌或肺炎链球菌引起的细菌性脑膜炎，101 例使用地塞米松，95 例使用地塞米松和甘油，92 例使用甘油，95 例使用安慰剂。只有就诊状态和年龄较小是所有阈值水平上听力受损的独立预测因素。格拉斯哥昏迷量表评分每降低一个点，风险增加 15%至 21%（比值比：1.20、1.21 和 1.15[95%可信区间：1.06-1.35、1.07-1.37 和 1.01-1.31]；P ＝.005、.003 和.039），分别表示存在听力损失、中重度至重度听力损失和重度听力损失。年龄每增加 1 个月，风险降低 2%至 6%（P ＝.0001、.0007 和.041）。无论病原体或抗菌药物的使用时间如何，地塞米松和甘油均不能预防这些水平的听力损失。
对于细菌性脑膜炎，患儿的就诊状态和年龄较小是听力损伤的最重要预测因素。目前的辅助性药物几乎没有缓解作用。
