早产儿支气管肺发育不良中使用类固醇的时机：与肺部和神经发育结局的关系。
Timing of postnatal steroids for bronchopulmonary dysplasia: association with pulmonary and neurodevelopmental outcomes.
机构信息
Department of Pediatrics, University of Iowa, Iowa City, IA, USA.
Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania, Philadelphia, PA, USA.
出版信息
J Perinatol. 2020 Apr;40(4):616-627. doi: 10.1038/s41372-020-0594-4. Epub 2020 Feb 4.
OBJECTIVE
To determine the associations between age at first postnatal corticosteroids (PNS) exposure and risk for severe bronchopulmonary dysplasia (BPD) and neurodevelopmental impairment (NDI).
STUDY DESIGN
Cohort study of 951 infants born <27 weeks gestational age at NICHD Neonatal Research Network sites who received PNS between 8 days of life (DOL) and 36 weeks' postmenstrual age was used to produce adjusted odds ratios (aOR).
RESULTS
Compared with infants in the reference group (22-28 DOL-lowest rate), aOR for severe BPD was similar for children given PNS between DOL 8 and 49 but higher among infants treated at DOL 50-63 (aOR 1.77, 95% CI 1.03-3.06), and at DOL ≥64 (aOR 3.06, 95% CI 1.44-6.48). The aOR for NDI did not vary significantly by age of PNS exposure.
CONCLUSION
For infants at high risk of BPD, initial PNS should be considered prior to 50 DOL for the lowest associated odds of severe BPD.
目的
确定首次产后皮质类固醇（PNS）暴露的年龄与严重支气管肺发育不良（BPD）和神经发育障碍（NDI）风险之间的关联。
研究设计
采用 NICHD 新生儿研究网络站点出生时胎龄<27 周的 951 例婴儿队列研究，这些婴儿在生命 8 天（DOL）至 36 周龄前接受 PNS 治疗，以生成调整后的优势比（aOR）。
结果
与参考组（22-28 DOL-最低发生率）相比，在 DOL 8 至 49 天接受 PNS 治疗的儿童中，严重 BPD 的 aOR 相似，但在 DOL 50-63 天（aOR 1.77，95%CI 1.03-3.06）和 DOL≥64 天（aOR 3.06，95%CI 1.44-6.48）治疗的婴儿中更高。PNS 暴露年龄与 NDI 的 aOR 无显著差异。
结论
对于患有严重 BPD 风险高的婴儿，为了将严重 BPD 的相关风险降到最低，应在 50 天 DOL 之前考虑首次使用 PNS。
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