Boscarino Giovanni, Cardilli Viviana, Conti Maria Giulia, Liguori Federica, Repole Paola, Parisi Pasquale, Terrin Gianluca
Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Pediatrics Unit, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Front Pediatr. 2024 Feb 14;12:1344337. doi: 10.3389/fped.2024.1344337. eCollection 2024.
Prolonged mechanical ventilation, commonly used to assist preterm newborns, increases the risk of developing bronchopulmonary dysplasia (BPD). In recent decades, studies have demonstrated that systemic corticosteroids play a significant role in the prevention and management of BPD. In this systematic review of randomized controlled trials (RCTs), we evaluated the association between the administration of systemic corticosteroids in preterm infants and its long-term outcomes, such as neurodevelopment, growth, extubation rate, and related adverse effects.
We conducted an electronic search in Medline, Scopus, and PubMed using the following terms: "premature infants" and "corticosteroids." We considered all RCTs published up to June 2023 as eligible. We included all studies involving preterm newborns treated with systemic corticosteroids and excluded studies on inhaled corticosteroids.
A total of 39 RCTs were evaluated. The influence of steroids administered systemically during the neonatal period on long-term neurological outcomes remains unknown, with no influence observed for long-term growth. The postnatal administration of systemic corticosteroids has been found to reduce the timing of extubation and improve respiratory outcomes. Dexamethasone appears to be more effective than hydrocortisone, despite causing a higher rate of systemic hypertension and hyperglycemia. However, in the majority of RCTs analyzed, there were no differences in the adverse effects related to postnatal corticosteroid administration.
Dexamethasone administered during the neonatal period appears to be more effective than hydrocortisone in terms of respiratory outcomes; however, caution should be taken when administering dexamethasone. Data derived from current evidence, including meta-analyses, are inconclusive on the long-term effects of the administration of systemic steroids in preterm infants or the possibility of neurodevelopmental consequences.
常用于辅助早产新生儿的长时间机械通气会增加发生支气管肺发育不良（BPD）的风险。近几十年来，研究表明全身用皮质类固醇在BPD的预防和管理中发挥着重要作用。在这项对随机对照试验（RCT）的系统评价中，我们评估了早产婴儿使用全身用皮质类固醇与神经发育、生长、拔管率及相关不良反应等长期结局之间的关联。
我们在Medline、Scopus和PubMed中使用以下检索词进行电子检索：“早产儿”和“皮质类固醇”。我们将截至2023年6月发表的所有RCT视为合格研究。我们纳入了所有涉及接受全身用皮质类固醇治疗的早产新生儿的研究，并排除了吸入性皮质类固醇的研究。
共评估了39项RCT。新生儿期全身使用类固醇对长期神经结局的影响尚不清楚，对长期生长未见影响。已发现出生后使用全身用皮质类固醇可缩短拔管时间并改善呼吸结局。地塞米松似乎比氢化可的松更有效，尽管其导致全身性高血压和高血糖的发生率更高。然而，在大多数分析的RCT中，出生后使用皮质类固醇相关的不良反应并无差异。
就呼吸结局而言，新生儿期使用地塞米松似乎比氢化可的松更有效；然而，使用地塞米松时应谨慎。包括荟萃分析在内的当前证据得出的数据对于早产婴儿使用全身类固醇的长期影响或神经发育后果的可能性尚无定论。
