Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, 44109, USA.
School of Medicine, Wright State University, Dayton, OH, 45402, USA.
Pediatr Res. 2023 Dec;94(6):1966-1972. doi: 10.1038/s41390-023-02673-4. Epub 2023 Jun 8.
We investigated the role of postnatal steroids on the severity of retinopathy of prematurity (ROP) and its impact on peripheral avascular retina (PAR).
A retrospective cohort study of infants born at ≤32 weeks gestation and/or birth weight ≤1500 g. Demographics, the dose and duration of steroid treatment, and age when full retinal vascularization occurred were collected. The primary outcomes were the severity of ROP and time to full vascularization of the retina.
A total of 1695 patients were enrolled, 67% of whom received steroid therapy. Their birth weight was 1142 ± 396 g and gestational age was 28.6 ± 2.7 weeks. The total hydrocortisone-equivalent dose prescribed was 28.5 ± 74.3 mg/kg. The total days of steroid treatment were 8.9 ± 35.1 days. After correction for major demographic differences, infants who received a higher cumulative dose of steroids for a longer duration had a significantly increased incidence of severe ROP and PAR (P < 0.001). For each day of steroid treatment, there was a 3.2% increase in the hazard of the severe form of ROP (95% CI: 1.022-1.043) along with 5.7% delay in achieving full retinal vascularization (95% CI: 1.04-1.08) (P < 0.001).
Cumulative dose and duration of postnatal steroid use were independently associated with the severity of ROP and PAR. Thus, postnatal steroids should be used very prudently.
We report ROP outcomes in a large cohort of infants from two major healthcare systems where we have studied the impact of postnatal steroids on the severity of ROP, growth, and development of retinal vessels. After correcting our data for three major outcome measures, we show that high-dose postnatal steroids used for a prolonged duration of time are independently associated with severe ROP and delay in retinal vascularization. Postnatal steroids impact the visual outcomes of VLBW infants significantly, so their clinical use needs to be moderated.
我们研究了产后类固醇对早产儿视网膜病变（ROP）严重程度的作用及其对周边无血管视网膜（PAR）的影响。
这是一项对出生胎龄≤32 周和/或出生体重≤1500g 的婴儿进行的回顾性队列研究。收集了人口统计学资料、类固醇治疗的剂量和持续时间以及完全视网膜血管化发生的年龄。主要结局是 ROP 的严重程度和视网膜完全血管化的时间。
共纳入 1695 例患者，其中 67%接受了类固醇治疗。他们的出生体重为 1142±396g，胎龄为 28.6±2.7 周。处方的总氢化可的松等效剂量为 28.5±74.3mg/kg。类固醇治疗的总天数为 8.9±35.1 天。在纠正主要人口统计学差异后，接受更高累积剂量和更长时间类固醇治疗的婴儿，ROP 严重程度和 PAR 的发生率显著增加（P<0.001）。每接受一天类固醇治疗，ROP 严重形式的发生风险增加 3.2%（95%CI：1.022-1.043），视网膜完全血管化的时间延迟 5.7%（95%CI：1.04-1.08）（P<0.001）。
产后类固醇的累积剂量和持续时间与 ROP 和 PAR 的严重程度独立相关。因此，应非常谨慎地使用产后类固醇。
我们报告了来自两个主要医疗保健系统的大量婴儿的 ROP 结局，研究了产后类固醇对 ROP 严重程度、视网膜血管生长和发育的影响。在对我们的三个主要结局指标进行数据校正后，我们发现，长时间高剂量使用产后类固醇与严重 ROP 和视网膜血管化延迟独立相关。产后类固醇显著影响极低出生体重儿的视觉结局，因此其临床应用需要适度。
