Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK; Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK.
J Pediatr. 2019 Dec;215:17-23. doi: 10.1016/j.jpeds.2019.07.062. Epub 2019 Sep 6.
To describe the effect of systemic corticosteroids administered to treat evolving bronchopulmonary dysplasia on oxygen diffusion and ventilation efficiency.
This was a retrospective cohort study of ventilated infants who received a 9-day course of dexamethasone in a tertiary neonatal unit. We calculated the transcutaneous oxygen saturation-to-fraction of inspired oxygen (FO) ratio (SFR), the ventilation perfusion ratio (V/Q), and the ventilation efficiency index (VEI) before, during, and after the course of corticosteroids. The response to corticosteroids was calculated as the difference between the FO percentage before starting steroids and the lowest FO value during the course of steroid treatment.
Seventy infants (38 males) with a median gestational age (GA) of 25.0 weeks (IQR, 24.3-26.0 weeks) and a median birth weight of 0.70 kg (IQR, 0.63-0.82 kg) were studied at a median postnatal age of 39 days (IQR, 29-48 days). The median SFR before treatment was 1.42 (IQR, 1.19-1.72), and the highest SFR was 2.35 (IQR, 1.87-2.83) after 9 days of treatment. The median V/Q before treatment was 0.14 (IQR, 0.11-0.18) and was significantly higher at 72 hours after the start of treatment (0.22; IQR, 0.15-0.29; P < .001). The median VEI was 0.06 (IQR, 0.04-0.08) before treatment and was highest, 0.10 (IQR, 0.07-0.13) at 48 hours after starting treatment. The median rate of response to corticosteroids was 28% (IQR, 20%-37%). GA was significantly related to the response to corticosteroids (ρ = 0.283; P = .019).
Oxygen diffusion continues to improve throughout the entire duration of a 9-day course of systemically administered corticosteroids in ventilated extremely preterm infants. More immature infants are less responsive to corticosteroids.
描述全身用皮质类固醇治疗进行性支气管肺发育不良对氧扩散和通气效率的影响。
这是一项对在三级新生儿病房接受 9 天疗程地塞米松治疗的呼吸机通气婴儿进行的回顾性队列研究。我们在接受皮质类固醇治疗前、治疗期间和治疗后计算经皮氧饱和度与吸入氧分数（FO）比（SFR）、通气灌注比（V/Q）和通气效率指数（VEI）。皮质类固醇治疗的反应通过开始使用类固醇前的 FO 百分比与类固醇治疗期间的最低 FO 值之间的差值来计算。
70 名婴儿（38 名男性）纳入研究，中位胎龄（GA）为 25.0 周（IQR，24.3-26.0 周），中位出生体重为 0.70 千克（IQR，0.63-0.82 千克），中位生后年龄为 39 天（IQR，29-48 天）。治疗前中位 SFR 为 1.42（IQR，1.19-1.72），治疗 9 天后最高 SFR 为 2.35（IQR，1.87-2.83）。治疗前中位 V/Q 为 0.14（IQR，0.11-0.18），治疗开始后 72 小时显著升高（0.22；IQR，0.15-0.29；P<.001）。治疗前中位 VEI 为 0.06（IQR，0.04-0.08），治疗开始后 48 小时最高，为 0.10（IQR，0.07-0.13）。皮质类固醇治疗的中位反应率为 28%（IQR，20%-37%）。GA 与皮质类固醇治疗的反应显著相关（ρ=0.283；P=0.019）。
在接受全身用皮质类固醇治疗的呼吸机通气极早产儿中，整个 9 天疗程期间氧扩散持续改善。不成熟的婴儿对皮质类固醇的反应性较低。
