在新生儿持续性肺动脉高压的治疗中使用补充性氢化可的松。
The use of supplemental hydrocortisone in the management of persistent pulmonary hypertension of the newborn.
机构信息
Department of Pediatrics, Duke University, Durham, NC, USA.
Duke Clinical Research Institute, Durham, NC, USA.
出版信息
J Perinatol. 2021 Apr;41(4):794-800. doi: 10.1038/s41372-021-00943-9. Epub 2021 Feb 15.
OBJECTIVE
Characterize association between hydrocortisone receipt and hospital outcomes of infants with persistent pulmonary hypertension of the newborn (PPHN).
STUDY DESIGN
Cohort study of infants ≥34 weeks with PPHN who received inhaled nitric oxide at <7 days of age (2010-2016). We generated propensity scores, and performed inverse probability-weighted regression to estimate hydrocortisone effect on outcomes: death, chronic lung disease (CLD), oxygen at discharge.
RESULTS
Of 2743 infants, 30% received hydrocortisone, which was associated with exposure to mechanical ventilation, sedatives, paralytics, or vasopressors (p < 0.001). There was no difference in death, CLD, or oxygen at discharge. In infants with meconium aspiration syndrome, hydrocortisone was associated with decreased oxygen at discharge (odds ratio 0.56; 95% confidence interval 0.21, 0.91).
CONCLUSIONS
There was no association between hydrocortisone receipt and death, CLD, or oxygen at discharge in our cohort. Prospective studies are needed to evaluate the effectiveness of hydrocortisone in infants with PPHN.
目的
描述接受氢化可的松治疗与新生儿持续性肺动脉高压（PPHN）患儿住院结局之间的关联。
研究设计
对 2010 年至 2016 年间接受过吸入一氧化氮治疗且胎龄≥34 周的患有 PPHN 的婴儿进行队列研究。我们生成了倾向评分，并进行了逆概率加权回归，以估计氢化可的松对结局（死亡、慢性肺病（CLD）、出院时吸氧）的影响。
结果
在 2743 名婴儿中，30%接受了氢化可的松治疗，与接受机械通气、镇静剂、肌松剂或血管加压剂治疗有关（p<0.001）。死亡、CLD 或出院时吸氧无差异。在胎粪吸入综合征婴儿中，氢化可的松与出院时吸氧减少相关（比值比 0.56；95%置信区间 0.21，0.91）。
结论
在我们的队列中，接受氢化可的松治疗与死亡、CLD 或出院时吸氧之间没有关联。需要前瞻性研究来评估氢化可的松治疗 PPHN 婴儿的有效性。
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