Smith Lucia J, van Asperen Peter P, McKay Karen O, Selvadurai Hiran, Fitzgerald Dominic A
Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
J Paediatr Child Health. 2011 Jul;47(7):448-54. doi: 10.1111/j.1440-1754.2010.01992.x. Epub 2011 Jun 28.
Infants born very prematurely often received corticosteroids to minimise the risk of developing bronchopulmonary dysplasia (BPD) but their long term impact on lung function at school age is unclear.
A cross-sectional study of 105 children [mean gestation of 27 weeks] was undertaken. Lung function assessments were conducted at a mean age of 10 years according to standard criteria. Corticosteroid dose was obtained from the medical record.
Spirometry in the BPD group was not significantly different to the non-BPD group, mean per-cent predicted (95% confidence interval) forced expiratory volume in 1 s (FEV1) 83% (79, 87) versus 86% (83, 90), FEF25%-75% 67% (60, 73) versus 75% (69, 81). Antenatal steroid treatment alone did not adversely affect airflow FEV1, 88% (84.92) versus 90% (82.97), and forced expiratory flow (FEF)25%-75%, 75% (69.81) versus 87% (70.104). Children who received post-natal corticosteroids had significantly lower flows than those who did not (FEV1 82% (78.85) vs. 88% (85.92), P = 0.006; FEF25%-75% 65% (59.71) vs. 78% (72.84), P = 0.003). Regression analysis revealed days on oxygen and days ventilated were statistically significant but weak predictors of airflow at 10 years of age.
A diagnosis of BPD did not predict reduced spirometry in middle childhood. Children who received post-natal corticosteroids as preterm infants had reduced expiratory flows compared with those who did not. While post-natal corticosteroids may be a marker of severity of lung disease, the potential of post-natal corticosteroids to influence lung development requires further investigation.
极早产婴儿常接受皮质类固醇治疗以降低发生支气管肺发育不良（BPD）的风险，但其对学龄期肺功能的长期影响尚不清楚。
对105名儿童[平均孕周27周]进行了一项横断面研究。根据标准标准，在平均年龄10岁时进行肺功能评估。从病历中获取皮质类固醇剂量。
BPD组的肺活量测定与非BPD组无显著差异，平均预测百分比（95%置信区间）1秒用力呼气量（FEV1）分别为83%（79，87）和86%（83，90），25%-75%用力呼气流量（FEF25%-75%）分别为67%（60，73）和75%（69，81）。仅产前使用类固醇治疗对气流没有不利影响，FEV1分别为88%（84.92）和90%（82.97），25%-75%用力呼气流量（FEF）分别为75%（69.81）和87%（70.104）。接受产后皮质类固醇治疗的儿童的气流明显低于未接受治疗的儿童（FEV1为82%（78.85）对88%（85.92），P = 0.006；FEF25%-75%为65%（59.71）对78%（72.84），P = 0.003）。回归分析显示，吸氧天数和通气天数具有统计学意义，但对10岁时气流的预测作用较弱。
BPD的诊断并不能预测儿童中期肺活量测定值降低。与未接受产后皮质类固醇治疗的儿童相比，早产时接受产后皮质类固醇治疗的儿童呼气流量降低。虽然产后皮质类固醇可能是肺部疾病严重程度的一个指标，但产后皮质类固醇对肺发育的影响潜力需要进一步研究。
