Interaction of hydrocortisone and illness severity on head growth in cohort of ELBW infants.
Interaction of hydrocortisone and illness severity on head growth in cohort of ELBW infants.
复制标题
氢化可的松与疾病严重程度对 ELBW 婴儿头部生长的相互作用。
DOI：
10.1038/s41390-023-02689-w
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发表时间：
2023
影响因子：
3.6
通讯作者：
Chavez-Valdez,Raul
中科院分区：
文献类型：
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作者：
Chen,Haiwen;Aziz,KhyzerB;Spahic,Harisa;Miller,Sarah;Guryildirim,Melike;Sellers,Austin;Brooks,Sandra;Kilborn,Alison;Everett,AllenD;Northington,FrancesJ;Stafstrom,CarlE;Chavez-Valdez,Raul
背景极低出生体重儿（ELBW）是易患神经发育障碍（NDD）的脆弱人群。全身性类固醇以前与NDD有关，但最近的研究表明，氢化可的松（HCT）可能在不增加NDD的情况下改善生存。然而，在NICU住院期间，HCT对疾病严重程度调整后的头部生长的影响尚不清楚。因此，我们假设HCT将保护头部生长，使用改进的新生儿顺序器官衰竭评估（M-nSOFA）评分来考虑疾病的严重程度。方法我们对23-29周胎龄（GA）和< 1000 g的婴儿进行了回顾性研究。我们的研究包括73名婴儿，其中41%接受了HCT。结果HCT患者的生长参数与年龄呈负相关，与对照组相似。接触hct的婴儿GA较低，但正常出生体重相似；接触hct的婴儿也有更高的疾病严重程度和更长的住院时间。我们发现HCT暴露与疾病严重程度之间对头部生长的相互作用，例如，当调整疾病严重程度时，暴露于HCT的婴儿与未暴露于HCT的婴儿相比，头部生长更好。结论：这些发现强调了考虑患者疾病严重程度的重要性，并表明HCT的使用可能会带来以前没有考虑到的额外益处。影响：这是第一个评估极低出生体重的极早产儿在新生儿重症监护室首次住院期间头部生长与疾病严重程度之间关系的研究。暴露于氢化可的松（HCT）的婴儿总体上比未暴露于氢化可的松（HCT）的婴儿患病更多，但暴露于HCT的婴儿相对于疾病严重程度有更好的头部生长保存。更好地了解接触艾滋病毒对这一脆弱人群的影响，将有助于指导就使用艾滋病毒的相对风险和益处作出更明智的决定。
BackgroundExtremely low birth weight (ELBW) infants comprise a fragile population at risk for neurodevelopmental disabilities (NDD). Systemic steroids were previously associated with NDD, but more recent studies suggest hydrocortisone (HCT) may improve survival without increasing NDD. However, the effects of HCT on head growth adjusted for illness severity during NICU hospitalization are unknown. Thus, we hypothesize that HCT will protect head growth, accounting for illness severity using a modified neonatal Sequential Organ Failure Assessment (M-nSOFA) score.MethodsWe conducted a retrospective study that included infants born at 23–29 weeks gestational age (GA) and < 1000 g. Our study included 73 infants, 41% of whom received HCT.ResultsWe found negative correlations between growth parameters and age, similar between HCT and control patients. HCT-exposed infants had lower GA but similar normalized birth weights; HCT-exposed infants also had higher illness severity and longer lengths of hospital stay. We found an interaction between HCT exposure and illness severity on head growth, such that infants exposed to HCT had better head growth compared to those not exposed to HCT when adjusted for illness severity.ConclusionThese findings emphasize the importance of considering patient illness severity and suggest that HCT use may offer additional benefits not previously considered.ImpactThis is the first study to assess the relationship between head growth and illness severity in extremely preterm infants with extremely low birth weights during their initial NICU hospitalization.Infants exposed to hydrocortisone (HCT) were overall more ill than those not exposed, yet HCT exposed infants had better preserved head growth relative to illness severity.Better understanding of the effects of HCT exposure on this vulnerable population will help guide more informed decisions on the relative risks and benefits for HCT use.