Department of Pediatrics, Faculty of Medicine and Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary.
Neonatal Intensive Care Unit, Department of Woman's and Child's Health, Padova University Hospital, Padova, Italy.
Pediatr Pulmonol. 2022 Mar;57(3):600-608. doi: 10.1002/ppul.25805. Epub 2022 Jan 12.
Bronchopulmonary dysplasia (BPD) is the most significant respiratory complication of prematurity, and its consequences last from birth into adulthood. Unfortunately, the dramatic improvements in the management of premature infants have not led to a decreased incidence of BPD, or to breakthroughs in treatments offered for this long-lasting chronic respiratory disorder. Over recent decades the pathological picture of BPD has changed from inflammation, interstitial fibrosis and emphysema attributed to volu-, barotrauma and oxygen toxicity to larger, simplified alveoli and dysmorphic vessels related to arrested alveolarization and vasculogenesis with inflammation maintaining a central role. Corticosteroids (CSs) play a key role in the development of respiratory epithelial cells and lung maturation. These potent anti-inflammatory agents have long been used for the prevention and treatment of BPD; however, the risk/benefit ratio of their use remains unresolved. CSs administered antenatally have contributed to reduce mortality and respiratory distress syndrome, no such effect on BPD reduction has been observed. Postnatal systemic CSs reduced the rate and severity of BPD, yet their long-term neurodevelopmental and respiratory consequences markedly limit routine administration. This is the first in a two-part State-of-the-Art series that reviews the latest relevant clinical trials investigating the short-term and long-term effects of CSs in the prevention and treatment of BPD.
支气管肺发育不良（BPD）是早产儿最严重的呼吸系统并发症，其后果从出生持续到成年。不幸的是，早产儿管理的显著改善并未导致 BPD 发病率降低，也未在这种长期慢性呼吸系统疾病的治疗方面取得突破。近几十年来，BPD 的病理表现已从归因于容积、气压伤和氧毒性的炎症、间质纤维化和肺气肿转变为与肺泡化和血管生成停滞相关的更大、更简单的肺泡和畸形血管，炎症仍起着核心作用。皮质类固醇（CSs）在呼吸上皮细胞和肺成熟中发挥着关键作用。这些强效抗炎药长期以来一直用于预防和治疗 BPD；然而，其使用的风险/收益比仍未得到解决。产前使用 CS 有助于降低死亡率和呼吸窘迫综合征，但对降低 BPD 没有观察到这种作用。全身用 CS 可降低 BPD 的发生率和严重程度，但它们对神经发育和呼吸系统的长期影响显著限制了常规应用。这是两部分最新临床研究综述系列的第一部分，该综述回顾了 CS 在预防和治疗 BPD 方面的短期和长期效果的最新相关临床试验。
