St Thomas Hospital, Neonatal Intensive Care Unit, Westminster Bridge Road, London SE1 7EH, United Kingdom of Great Britain and Northern Ireland.
St Thomas Hospital, Neonatal Intensive Care Unit, Westminster Bridge Road, London SE1 7EH, United Kingdom of Great Britain and Northern Ireland.
Early Hum Dev. 2022 Aug;171:105630. doi: 10.1016/j.earlhumdev.2022.105630. Epub 2022 Jul 15.
To assess the safety of the routine use of low-dose prophylactic hydrocortisone to improve survival without bronchopulmonary dysplasia (BPD) in infants born <28 weeks' gestation.
A single-centre retrospective cohort study of infants born <28 weeks, before and after hydrocortisone implementation. Data was collected from electronic patient records and compared between both groups.
The incidence of serious adverse events associated with hydrocortisone use was measured in each group. The rates of spontaneous intestinal perforation (SIP), late onset sepsis (LOS). Necrotising enterocolitis (NEC) and BPD were compared.
There were 88 infants in the pre-hydrocortisone group and 103 infants in the hydrocortisone group. In comparison to the pre-hydrocortisone group, the incidence of SIP in the hydrocortisone group was 7.7 % (vs 3.4 % p = 0.2), NEC 30 % (vs 25 % p = 0.43) and LOS 34 % (vs 30.6 % p = 0.63) Rates of BPD in the hydrocortisone group were 59 % (vs 52.2 % p = 0.33) mortality 18.4 % (vs 20.4 % p = 0.73) and BPD free survival 26.2 % (vs 27.2 % p = 0.87). Infants who received hydrocortisone had a significantly lower requirement of inotropic support of 32 % vs 48.3 % (p = 0.02). Results remained unchanged after logistic regression analyses for potential confounding factors (ethnicity, chorioamnionitis, multiple pregnancy and antenatal steroids).
Prophylactic administration of low-dose hydrocortisone for BPD to infants born below 28 weeks' gestation was not associated with an increase in serious adverse outcomes in our population.
评估小剂量皮质醇预防用药对改善 28 周以下早产儿支气管肺发育不良（BPD）存活率的安全性。
单中心回顾性队列研究，纳入 28 周以下出生的婴儿，比较皮质醇应用前后的数据。数据来自电子病历，并在两组之间进行比较。
比较两组皮质醇应用相关严重不良事件的发生率。比较自发性肠穿孔（SIP）、晚发性败血症（LOS）、坏死性小肠结肠炎（NEC）和 BPD 的发生率。
皮质醇组 103 例，皮质醇组 88 例。与皮质醇组相比，SIP 发生率为 7.7%（vs 3.4%，p=0.2），NEC 发生率为 30%（vs 25%，p=0.43），LOS 发生率为 34%（vs 30.6%，p=0.63）。皮质醇组 BPD 发生率为 59%（vs 52.2%，p=0.33），死亡率为 18.4%（vs 20.4%，p=0.73），BPD 无生存 26.2%（vs 27.2%，p=0.87）。接受皮质醇治疗的婴儿对正性肌力支持的需求明显降低，分别为 32%和 48.3%（p=0.02）。多因素逻辑回归分析潜在混杂因素（种族、绒毛膜羊膜炎、多胎妊娠和产前类固醇）后，结果仍然不变。
在我们的人群中，对 28 周以下出生的早产儿预防性使用小剂量皮质醇治疗 BPD 并不增加严重不良事件。
