Peeples E S
Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA.
J Perinatol. 2017 Aug;37(8):943-946. doi: 10.1038/jp.2017.68. Epub 2017 May 18.
The objective of the study was to compare blood pressure, vasoactive medication requirements and adverse outcomes after administration of high- versus low-dose hydrocortisone (HC) in preterm infants.
This is a retrospective analysis of 106 infants ⩽28 weeks gestational age with hypotension requiring vasoactive infusions and high-dose (4 mg kg per day, n=50), low-dose (1 to 3 mg kg per day, n=20) or no HC (n=36) from 2011 to 2015. Groups were compared by two-tailed t-test or χ, and correlation estimated by multivariable logistic regression.
There were no differences in measured efficacy between the low- and high-dose groups. Infants with pre-treatment cortisol >15 mcg dl who received HC therapy showed less improvement in vasoactive burden, increased hyperglycemia (P=0.015) and increased death independent of HC dose (odds ratio 26.3, 3.5 to 198.3, P=0.002).
These results support using the lowest effective HC dose in preterm infants. In addition, HC therapy should likely be avoided in infants who are not cortisol deficient.
本研究的目的是比较早产儿使用高剂量与低剂量氢化可的松（HC）后的血压、血管活性药物需求及不良结局。
这是一项对2011年至2015年间106例胎龄≤28周、患有低血压且需要血管活性药物输注的婴儿进行的回顾性分析。这些婴儿接受高剂量（每天4毫克/千克，n = 50）、低剂量（每天1至3毫克/千克，n = 20）或不接受HC治疗（n = 36）。通过双尾t检验或χ检验对各组进行比较，并通过多变量逻辑回归估计相关性。
低剂量组和高剂量组在测量的疗效方面没有差异。接受HC治疗的治疗前皮质醇>15微克/分升的婴儿在血管活性负担方面改善较少，高血糖增加（P = 0.015），且与HC剂量无关的死亡增加（比值比26.3，3.5至198.3，P = 0.002）。
这些结果支持在早产儿中使用最低有效剂量的HC。此外，对于非皮质醇缺乏的婴儿，可能应避免使用HC治疗。
