Hochwald Ori, Palegra Gustavo, Osiovich Horacio
Neonatal Intensive Care Unit, Rambam Medical Center, 6th Haalyia st., Haifa, Israel,
Indian J Pediatr. 2014 Aug;81(8):808-10. doi: 10.1007/s12098-013-1151-3. Epub 2013 Aug 1.
In this pilot study the authors demonstrate the feasibility, effectiveness and safety of the combined early treatment with hydrocortisone and dopamine for refractory hypotension in preterm newborns. Very low birth weight infants born at gestational age < 30 wk or birth weight < 1250 g in the first 48 h of life with hypotension after receiving 10-20 mL/kg bolus of normal saline, were randomized to receive concurrently with the initiation of dopamine, intravenous hydrocortisone (11 infants) or an equivalent volume of placebo (11 infants). Despite no significant clinical difference between the groups including gestational age, birth weight, prevalence of chorioamnionitis, prenatal steroid treatment, cord PH, baseline cortisol level, there was a trend towards lower incidence of bronchopulmonary dysplasia (BPD), and higher survival without BPD rate in the hydrocortisone group. In this very sick small group of infants, hydrocortisone was not associated with more adverse effects, but rather showed a trend toward association with better outcome, including survival without BPD.
在这项初步研究中，作者证明了氢化可的松和多巴胺联合早期治疗对早产新生儿难治性低血压的可行性、有效性和安全性。孕周<30周或出生体重<1250g的极低出生体重儿在出生后48小时内出现低血压，在接受10 - 20 mL/kg生理盐水推注后，被随机分为两组，一组在开始使用多巴胺的同时静脉注射氢化可的松（11例婴儿），另一组注射等量安慰剂（11例婴儿）。尽管两组在胎龄、出生体重、绒毛膜羊膜炎患病率、产前类固醇治疗、脐血pH值、基线皮质醇水平等方面无显著临床差异，但氢化可的松组支气管肺发育不良（BPD）的发生率有降低趋势，且无BPD的生存率更高。在这组病情非常严重的小婴儿中，氢化可的松并未导致更多不良反应，反而显示出与更好结局相关的趋势，包括无BPD存活。
