Wald E R, Kaplan S L, Mason E O, Sabo D, Ross L, Arditi M, Wiedermann B L, Barson W, Kim K S, Yogov R
University of Pittsburgh School of Medicine, Pennsylvania, USA.
Pediatrics. 1995 Jan;95(1):21-8.
To determine whether treatment with dexamethasone and ceftriaxone for children with bacterial meningitis reduces the frequency of either sensorineural hearing loss or other neurologic sequelae.
This was a prospective, multicentered, placebo-controlled clinical trial. Subjects were followed for 1 year.
The study was conducted in six children's hospitals located in Pittsburgh, Houston, Los Angeles, Chicago, Washington, D.C., and Columbus, Ohio.
Enrolled were 173 children, 8 weeks to 12 years of age, with suspected bacterial meningitis; 143 children were evaluable. Eighty-seven percent of patients were followed for at least 6 weeks to 3 months, and 67% were followed for 1 year.
Subjects were randomized to receive ceftriaxone with or without dexamethasone (0.15 mg/kg every 6 hours for 4 days). Auditory brainstem responses (ABR) were measured within 24 hours of admission.
Hearing, development, and neurologic sequelae were assessed at the time of discharge and 6 weeks and 1 year later.
One hundred forty-three patients (69 received dexamethasone and 74 received placebo) with bacterial meningitis were evaluable: Haemophilus influenzae type b (83), Streptococcus pneumoniae (33), Neisseria meningitidis (24), and three others. Overall, there was no significant difference in auditory outcome between dexamethasone and placebo recipients. Twenty-two children had bilateral moderate or more severe hearing loss at the time of the first ABR. At follow-up, the resolution of hearing impairment was nearly identical for each group. Nine of ten children who remained persistently deaf were deaf at the time of the first ABR. There were no differences in neurologic or developmental outcome between groups.
All but one child with persistent bilateral moderate or more severe hearing loss had demonstrable deafness at the time of the first ABR. Dexamethasone did not significantly improve audiologic, neurologic, or developmental outcome in children with bacterial meningitis.
确定地塞米松和头孢曲松联合治疗细菌性脑膜炎患儿是否能降低感音神经性听力损失或其他神经后遗症的发生率。
这是一项前瞻性、多中心、安慰剂对照临床试验。对受试者进行了1年的随访。
该研究在位于匹兹堡、休斯顿、洛杉矶、芝加哥、华盛顿特区和俄亥俄州哥伦布市的六家儿童医院进行。
纳入了173名8周龄至12岁疑似细菌性脑膜炎的儿童；143名儿童可进行评估。87%的患者随访了至少6周至3个月，67%的患者随访了1年。
受试者被随机分为接受头孢曲松加或不加地塞米松（每6小时0.15mg/kg，共4天）治疗。入院后24小时内测量听觉脑干反应（ABR）。
在出院时、6周后和1年后评估听力、发育和神经后遗症情况。
143例细菌性脑膜炎患者（69例接受地塞米松治疗，74例接受安慰剂治疗）可进行评估：其中b型流感嗜血杆菌感染83例、肺炎链球菌感染33例、脑膜炎奈瑟菌感染24例，其他感染3例。总体而言，地塞米松治疗组和安慰剂治疗组在听觉结局方面无显著差异。22名儿童在首次ABR检查时出现双侧中度或更严重听力损失。在随访中，两组听力障碍的恢复情况几乎相同。10名持续耳聋的儿童中有9名在首次ABR检查时就已耳聋。两组在神经或发育结局方面无差异。
除1名儿童外，所有持续性双侧中度或更严重听力损失的儿童在首次ABR检查时均已出现明显耳聋。地塞米松并未显著改善细菌性脑膜炎患儿的听力、神经或发育结局。
