Neonatology, University Hospital Croix Rousse, Hospices Civils de Lyon, Lyon, France.
Acta Paediatr. 2013 Jul;102(7):689-94. doi: 10.1111/apa.12255. Epub 2013 Apr 29.
To compare the efficacy and tolerance of betamethasone (BTM) and hydrocortisone (HC) in weaning extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) from the ventilator.
Monocentric, retrospective, cohort analysis based on prospective, standardized collection of data between 2005 and 2011 in ELBW receiving postnatal steroids (PS) after the second week of life. We used BTM for the first 4 years, and thereafter HC. We compared extubation rates, growth, glycaemia and blood pressure.
Sixty-seven infants received PS: 35 BTM and 32 HC. Most infants (83% BTM vs. 72% HC) were extubated during treatment (p = 0.281). During PS, the need for insulin was similar. Mean arterial blood pressure was similar at day 3 of PS, but was significantly lower in infants treated by BTM 30 days after the end of treatment. The z-scores for body weight and head circumference indicated significantly greater loss in BTM than HC group. This persisted only for body weight after adjustment for differences in energy intake and corticosteroid dose.
Our study suggests that HC may be as efficient as BTM in facilitating the extubation of ELBW infants, without short-term adverse effects. Blood pressure monitoring and investigation of long-term neurodevelopment are nevertheless needed.
比较倍他米松（BTM）和氢化可的松（HC）在撤机治疗支气管肺发育不良（BPD）极低出生体重儿（ELBW）中的疗效和耐受性。
采用单中心、回顾性、队列分析方法，对 2005 年至 2011 年出生后第二周接受PS 的 ELBW 患儿进行前瞻性、标准化数据收集。我们前 4 年使用 BTM，之后使用 HC。我们比较了两组患儿的拔管率、生长情况、血糖和血压。
67 名患儿接受了 PS：35 名使用 BTM，32 名使用 HC。大多数患儿（83% BTM 与 72% HC）在治疗期间拔管（p = 0.281）。PS 期间，胰岛素的需求相似。PS 第 3 天的平均动脉血压相似，但在治疗结束后 30 天，接受 BTM 治疗的患儿明显降低。体重和头围的 z 评分表明 BTM 组体重下降明显大于 HC 组。在调整能量摄入和皮质激素剂量的差异后，这种情况仅在体重方面仍然存在。
我们的研究表明，HC 可能与 BTM 同样有效地促进 ELBW 患儿拔管，且无短期不良影响。但仍需要进行血压监测和长期神经发育的研究。
