Kandraju Hemasree, Jasani Bonny, Shah Prakesh S, Church Paige T, Luu Thuy Mai, Ye Xiang Y, Stavel Miroslav, Mukerji Amit, Shah Vibhuti
Department of Paediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada.
Division of Neonatology, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
Children (Basel). 2022 Nov 3;9(11):1687. doi: 10.3390/children9111687.
Objective: To determine the association between postnatal age (PNA) at first administration of systemic postnatal steroids (sPNS) for bronchopulmonary dysplasia (BPD) and mortality or significant neurodevelopmental impairment (sNDI) at 18−24 months corrected age (CA) in infants < 29 weeks’ gestation. Methods: Data from the Canadian Neonatal Network and Canadian Neonatal Follow-up Network databases were used to conduct this retrospective cohort study. Infants exposed to sPNS for BPD after the 1st week of age were included and categorized into 8 groups based on the postnatal week of the exposure. The primary outcome was a composite of mortality or sNDI. A multivariable logistic regression model adjusting for potential confounders was used to determine the association between the sPNS and ND outcomes. Results: Of the 10,448 eligible infants, follow-up data were available for 6200 (59.3%) infants. The proportion of infants at first sPNS administration was: 8%, 17.5%, 23.1%, 18.7%, 12.6%, 8.3%, 5.8%, and 6% in the 2nd, 3rd, 4th, 5th, 6th, 7th, 8−9th, and ≥10th week of PNA respectively. No significant association between the timing of sPNS administration and the composite outcome of mortality or sNDI was observed. The odds of sNDI and Bayley-III motor composite < 70 increased by 1.5% (95% CI 0.4, 2.9%) and 2.6% (95% CI 0.9, 4.4%), respectively, with each one-week delay in the age of initiation of sPNS. Conclusions: No significant association was observed between the composite outcome of mortality or sNDI and PNA of sPNS. Among survivors, each week’s delay in initiation of sPNS may increase the odds of sNDI and motor delay.
确定胎龄小于29周的婴儿首次给予全身性产后类固醇（sPNS）治疗支气管肺发育不良（BPD）时的产后年龄（PNA）与18至24个月矫正年龄（CA）时的死亡率或严重神经发育障碍（sNDI）之间的关联。方法：使用加拿大新生儿网络和加拿大新生儿随访网络数据库的数据进行这项回顾性队列研究。纳入出生后第1周后接受sPNS治疗BPD的婴儿，并根据暴露的产后周数分为8组。主要结局是死亡率或sNDI的综合指标。使用调整潜在混杂因素的多变量逻辑回归模型来确定sPNS与神经发育结局之间的关联。结果：在10448名符合条件的婴儿中，有6200名（59.3%）婴儿有随访数据。首次给予sPNS时婴儿的比例分别为：PNA第2周8%、第3周17.5%、第4周23.1%、第5周18.7%、第6周12.6%、第7周8.3%、第8 - 9周5.8%、≥第10周6%。未观察到sPNS给药时间与死亡率或sNDI综合结局之间存在显著关联。sPNS开始年龄每延迟一周，sNDI的几率增加1.5%（95%CI 0.4，2.9%），贝利-III运动综合评分<70的几率增加2.6%（95%CI 0.9，4.4%）。结论：未观察到死亡率或sNDI综合结局与sPNS的PNA之间存在显著关联。在幸存者中，sPNS开始时间每延迟一周可能会增加sNDI和运动发育迟缓的几率。
