A CONTROLLED TRIAL OF DEXAMETHASONE IN PRETERM INFANTS AT HIGH-RISK FOR BRONCHOPULMONARY DYSPLASIA
A CONTROLLED TRIAL OF DEXAMETHASONE IN PRETERM INFANTS AT HIGH-RISK FOR BRONCHOPULMONARY DYSPLASIA
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DOI：
10.1056/nejm198906083202301
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发表时间：
1989-06-08
影响因子：
158.5
通讯作者：
GROSS, SJ
中科院分区：
文献类型：
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作者：
CUMMINGS, JJ;DEUGENIO, DB;GROSS, SJ
我们在一项随机、双盲、安慰剂对照试验中评估了早产儿使用地塞米松以降低与支气管肺发育不良相关的发病率。36名早产儿（出生体重，体重）。1250克和胎龄，1。2周龄依赖氧气和机械通气的患者分别接受42天疗程的地塞米松治疗（n = 13）、18天疗程的地塞米松治疗（n = 12）或生理盐水安慰剂治疗（n = 11）。地塞米松的起始剂量为每天每公斤体重0.5 mg，在给药期间逐渐降低。42天地塞米松组婴儿脱离机械通气（中位数分别为29、73和84天，P < 0.05）和补充氧（中位数分别为65、190和136天，P < 0.05）的速度明显快于对照组婴儿，而18天组婴儿则没有。未见类固醇给药的临床并发症。所有23名幸存者在6个月和15个月大时的随访结果良好（神经系统检查和Bayley发育指数正常）。84) 42天地塞米松组9例中有7例，18天地塞米松组9例中仅有2例，安慰剂组5例中仅有2例（P < 0.05）。我们得出结论，地塞米松治疗42天可改善极低出生体重、支气管肺发育不良高风险婴儿的肺和神经发育结局。
We evaluated the use of dexamethasone in preterm infants to decrease morbidity associated with bronchopulmonary dysplasia in a randomized, double-blind, placebo-controlled trial. Thirty-six preterm infants (birth weight, .ltoreq. 1250 g and gestational age, .ltoreq. 30 weeks) who were dependent on oxygen and mechanical ventilation at two weeks of age received a 42-day course of dexamethasone (n = 13), an 18-day course of dexamethasone (n = 12), or saline placebo (n = 11). The starting dose of dexamethasone was 0.5 mg per kilogram of body weight per day, and it was progressively lowered during the period of administration. Infants in the 42-day dexamethasone group, but not those in the 18-day group, were weaned from mechanical ventilation significantly faster than control infants (medians 29, 73, and 84 days, respectively; P < 0.05), and from supplemental oxygen (medians 65, 190, and 136 days, respectively; P < 0.05). No clinical complications of steroid administration were noted. Follow-up of all 23 survivors at 6 and 15 months of age showed good outcome (normal neurologic examinations and Bayley Developmental indexes .gtoreq. 84) in 7 of the 9 infants in the 42-day dexamethasone group, but in only 2 of the 9 infants in the 18-day dexamethasone group and 2 of the 5 in the placebo group (P < 0.05). We conclude that dexamethasone therapy for 42 days improves pulmonary and neurodevelopmental outcome in very-low-birth-weight infants at high risk for bronchopulonary dysplasia.