Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Perinatol. 2012 Sep;32(9):685-9. doi: 10.1038/jp.2011.166. Epub 2011 Nov 17.
Following patent ductus arteriosus (PDA) ligation, preterm infants may develop profound hypotension and respiratory failure. Prophylactic stress hydrocortisone (HC) has emerged as a therapy to prevent complications, postulating these infants do not synthesize steroids because of an immature hypothalamic-pituitary-adrenal axis. The purpose of this study was to compare outcomes in infants who received stress HC before their PDA ligations to those who did not.
A retrospective chart review was performed of infants who underwent PDA ligations at our institution's neonatal intensive care unit. Data were collected on treatment with HC, and respiratory and cardiovascular support.
Gestational age (GA) and birth weight were lower in the HC group (24 vs 25 weeks, 632 vs 790 g), but age at time of surgery was similar (26 vs 21 days). Cardiorespiratory support was comparable between the groups pre- and post-operatively. In regression models that adjusted for GA, HC treatment was not independently related to respiratory support postoperatively, but was associated with a decrease in postoperative dopamine (2.2 mcg kg(-1) min(-1); P=0.03). Respiratory support postoperatively was predicted by preoperative respiratory support. GA and age at surgery were not independently associated with outcome.
Preoperative stress HC was not associated with improved cardiorespiratory stability, regardless of GA. Further investigation is needed to identify infants who may benefit from this therapy.
动脉导管未闭（PDA）结扎后，早产儿可能会出现严重低血压和呼吸衰竭。预防性应激氢化可的松（HC）已成为预防并发症的一种治疗方法，其假设是这些婴儿由于下丘脑-垂体-肾上腺轴不成熟而无法合成类固醇。本研究旨在比较接受 PDA 结扎前接受应激 HC 治疗的婴儿与未接受应激 HC 治疗的婴儿的结局。
对在我们机构新生儿重症监护病房接受 PDA 结扎的婴儿进行了回顾性图表审查。收集了关于 HC 治疗以及呼吸和心血管支持的数据。
HC 组的胎龄（GA）和出生体重较低（24 周对 25 周，632 克对 790 克），但手术时的年龄相似（26 天对 21 天）。两组术前和术后的心肺支持相似。在调整 GA 的回归模型中，HC 治疗与术后呼吸支持无关，但与术后多巴胺用量减少相关（2.2 mcg·kg-1·min-1；P=0.03）。术后呼吸支持可由术前呼吸支持预测。GA 和手术时的年龄与结局无关。
无论 GA 如何，术前应激 HC 与改善心肺稳定性无关。需要进一步研究以确定可能受益于这种治疗的婴儿。
