Division of Neonatology, Department of Pediatrics, Baylor University Medical Center and Pediatrix Medical Group, Dallas, TX.
Department of Child Health, Banner University Medical Center and the University of Arizona College of Medicine, Phoenix, AZ.
J Pediatr. 2019 Apr;207:143-147.e3. doi: 10.1016/j.jpeds.2018.11.023. Epub 2018 Dec 21.
To characterize common dosing strategies and to investigate the association between hydrocortisone dosage and in-hospital mortality in infants born extremely premature.
We performed a retrospective review of a cohort of infants born ≤30 weeks' gestational age from 2010 to 2016 from the Pediatrix Clinical Data Warehouse who received hydrocortisone in the first 14 postnatal days. Infants were divided by initial hydrocortisone dosage (high: >2 mg/kg/d vs low: ≤2 mg/kg/d). Baseline characteristics and medication coexposures were compared and mortality was evaluated in a multivariable analysis.
A total of 1427 infants were included, 733 with high dosage (51%) and 694 with low dosage (49%). The groups were similar with regard to baseline characteristics. Infants in the high-dosage group had significantly more exposure to any vasopressors (89% vs 84%, P < .001) and greater mortality (50% vs 23%, P < .001) vs the low-dosage group. High dosage of hydrocortisone was associated independently with death (aOR 3.27, 95% CI 2.47-4.34, P < .001) in a multivariable regression analysis including propensity scoring for dosage and other covariates. When the cohort was split into quartiles by dosage, mortality was lower in the lower-dosage quartiles compared with the higher quartiles (mortality range 13%-50%).
In this retrospective analysis of a large sample of infants born premature, increased initial hydrocortisone dosage was associated independently with increased mortality. Trials to assess the impact of hydrocortisone dosage in this population are needed.
描述常见的给药策略，并研究氢化可的松剂量与极早产儿院内死亡率之间的关系。
我们对 2010 年至 2016 年期间来自 Pediatrix 临床数据仓库的出生胎龄≤30 周的婴儿进行了回顾性分析，这些婴儿在出生后 14 天内接受了氢化可的松治疗。根据初始氢化可的松剂量（高剂量：>2mg/kg/d 与低剂量：≤2mg/kg/d）将婴儿分为两组。比较了两组的基线特征和药物共暴露情况，并在多变量分析中评估了死亡率。
共纳入 1427 名婴儿，其中高剂量组 733 名（51%），低剂量组 694 名（49%）。两组在基线特征方面相似。高剂量组的婴儿接受任何血管加压药的暴露率明显更高（89%比 84%，P<0.001），死亡率也更高（50%比 23%，P<0.001）。多变量回归分析包括剂量和其他协变量的倾向评分，结果显示，高剂量的氢化可的松与死亡独立相关（优势比 3.27，95%置信区间 2.47-4.34，P<0.001）。当根据剂量将队列分为四分位时，较低剂量四分位的死亡率低于较高四分位（死亡率范围 13%-50%）。
在这项对大量早产儿进行的回顾性分析中，初始氢化可的松剂量增加与死亡率增加独立相关。需要进行评估该人群中氢化可的松剂量影响的试验。
