Szabó Hajnalka, Baraldi Eugenio, Colin Andrew A
Department of Pediatrics, Faculty of Medicine & 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 Apr;57(4):787-795. doi: 10.1002/ppul.25808. Epub 2022 Jan 12.
This paper is the second 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 corticosteroids in the prevention and treatment of bronchopulmonary dysplasia (BPD). Inhaled postnatal corticosteroids demonstrate low systemic bioavailability and rapid systemic clearance with high pulmonary deposition and were expected to reduce the incidence of BPD with reduced adverse effects, however, increased rate of mortality in the neonatal period and at the 18-24 months follow-up was observed. In a milestone study, intratracheal instillation of corticosteroids combined with surfactant decreased the incidence of BPD without increasing the mortality or the long-term neurodevelopmental adverse outcomes. However, subsequent trials using different types of surfactants, different surfactant to budesonide ratio, different time of the drug administration for infants with different severity of respiratory distress syndrome could not reproduce all the beneficial effects. Future perspectives for the identification of premature infants at high risk of BPD and the prevention or treatment of established BPD are discussed.
本文是“最新技术”系列文章的第二篇，该系列共两部分，回顾了调查皮质类固醇在预防和治疗支气管肺发育不良（BPD）方面短期和长期效果的最新相关临床试验。吸入性产后皮质类固醇具有低全身生物利用度和快速全身清除率，且肺部沉积率高，预计可降低BPD的发生率并减少不良反应，然而，在新生儿期以及18至24个月随访时观察到死亡率有所增加。在一项具有里程碑意义的研究中，气管内滴注皮质类固醇联合表面活性剂可降低BPD的发生率，且不增加死亡率或长期神经发育不良结局。然而，随后使用不同类型表面活性剂、不同表面活性剂与布地奈德比例、针对不同严重程度呼吸窘迫综合征婴儿的不同给药时间进行的试验，未能重现所有有益效果。文中还讨论了识别BPD高危早产儿以及预防或治疗已确诊BPD的未来前景。
