Renault Anaïs, Patkaï Juliana, Dassieu Gilles, El Ayoubi Mayass, Canouï-Poitrine Florence, Durrmeyer Xavier
Neonatal Intensive Care Unit, CHI Créteil, Créteil, France.
Neonatal Intensive Care Unit, AP-HP, Maternité Cochin-Port Royal, Paris, France.
Acta Paediatr. 2016 Sep;105(9):1047-55. doi: 10.1111/apa.13487. Epub 2016 Jun 24.
We assessed the outcomes of ventilated extremely premature infants treated with late postnatal corticosteroids from 2005-2008, according to permissive or restrictive policies in two centres.
This retrospective study included inborn infants below 27 weeks of gestational age who were ventilator dependent after 14 days. Centre P permitted postnatal corticosteroids but centre R restricted their use. The effects on infants were assessed in hospital and after two years using multivariable analysis.
We compared 62 infants from centre P, including 92% who received hydrocortisone, and 48 infants from centre R, including 13% who received betamethasone. Infants from both centres had comparable baseline characteristics and perinatal management, but bronchopulmonary dysplasia (BPD) rates were significantly lower in centre P (30% versus 71%, p < 0.001) and this centre was significantly associated with a younger post-conceptional age at oxygen weaning, with an adjusted hazard ratio (aHR) of 0.45 and an aHR of 0.51at discharge. At two years of corrected age, 18% of centre P infants and 30% of centre R infants showed poor neurodevelopmental outcome (p = 0.18).
Using hydrocortisone after 14 days on ventilated extremely preterm infants was associated with decreased BPD, with no apparent effects on neurodevelopment at two years of corrected age.
我们根据两个中心的宽松或严格政策，评估了2005年至2008年接受出生后晚期皮质类固醇治疗的机械通气极早产儿的结局。
这项回顾性研究纳入了胎龄小于27周、14天后仍依赖机械通气的足月儿。中心P允许使用出生后皮质类固醇，而中心R限制其使用。使用多变量分析评估对婴儿在医院及两年后的影响。
我们比较了中心P的62例婴儿，其中92%接受了氢化可的松治疗，以及中心R的48例婴儿，其中13%接受了倍他米松治疗。两个中心的婴儿具有可比的基线特征和围产期管理，但中心P的支气管肺发育不良（BPD）发生率显著较低（30%对71%，p<0.001），且该中心与氧疗断奶时较年轻的孕龄显著相关，调整后的风险比（aHR）为0.45，出院时为0.51。在矫正年龄两岁时，中心P的18%婴儿和中心R的30%婴儿显示神经发育结局不良（p=0.18）。
对机械通气的极早产儿在14天后使用氢化可的松与BPD减少相关，在矫正年龄两岁时对神经发育无明显影响。
