Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: A multicenter, international, randomized, controlled trial
Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: A multicenter, international, randomized, controlled trial
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DOI：
10.1542/peds.2004-2843
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发表时间：
2006-01-01
期刊：
影响因子：
8
通讯作者：
Carlin, JB
中科院分区：
文献类型：
--
作者：
Doyle, LW;Davis, PG;Carlin, JB
目标。出生后皮质类固醇治疗是有争议的。本研究的目的是确定小剂量地塞米松治疗慢性呼吸机依赖新生儿的短期效果。方法：极早产(胎龄：28周)或极低出生体重(出生体重：<；1000 g)出生后1周后依赖呼吸机的婴儿符合条件，被随机分配给面罩地塞米松(0.89 mg/kg，连续10天)或生理盐水安慰剂。结果：从11个中心招募了70名婴儿，平均年龄23天。治疗10天后，地塞米松组拔管成功率(60%，21/35)高于对照组(12%，4/34)(优势比[OR]：11.2；95%可信区间[CI]：3.2~39.0)。呼吸机和氧气需求显著改善，插管持续时间缩短。在36周时，死亡率(地塞米松组：11%；对照组：20%；OR：0.52；95%CI：0.14~1.95)或氧依赖率(地塞米松组：85%；对照组：91%；OR：0.58；95%CI：0.13~2.66)几乎没有下降的迹象。小剂量地塞米松对血糖浓度、血压或其他并发症没有明显影响。无一例发生肠穿孔。结论：出生1周后小剂量的地塞米松治疗明显促进了依赖呼吸机的极早产/极低出生体重儿的拔管，缩短了插管时间，没有任何明显的短期并发症。结合最近的证据表明，从长远来看，具有极高支气管肺发育不良风险的婴儿可能会受益，我们的研究重新引发了关于低剂量、出生后晚期皮质类固醇治疗的作用的辩论。
OBJECTIVE. Postnatal corticosteroid therapy is controversial. The aim of this study was to determine the short-term effects of low-dose dexamethasone treatment among chronically ventilator-dependent neonates.METHODS. Very preterm (gestational age: < 28 weeks) or extremely low birth weight (birth weight: < 1000 g) infants who were ventilator dependent after the first 1 week of life were eligible and were assigned randomly to receive masked dexamethasone (0.89 mg/kg over 10 days) or saline placebo. Data on ventilator and oxygen requirements and deaths were recorded.RESULTS. Seventy infants were recruited from 11 centers, at a median age of 23 days. More infants were extubated successfully by 10 days of treatment in the dexamethasone group (60%, 21 of 35 patients) than in the control group (12%, 4 of 34 patients) (odds ratio [OR]: 11.2; 95% confidence interval [CI]: 3.2-39.0). Ventilator and oxygen requirements improved substantially, and the duration of intubation was shorter. There was little evidence for a reduction in either the mortality rate (dexamethasone group: 11%; control group: 20%; OR: 0.52; 95% CI: 0.14-1.95) or the rate of oxygen dependence at 36 weeks (dexamethasone group: 85%; control group: 91%; OR: 0.58; 95% CI: 0.13-2.66). There were no obvious effects of low-dose dexamethasone on blood glucose concentrations, blood pressure, or other complications. No infant experienced intestinal perforation.CONCLUSIONS. Low-dose dexamethasone treatment after the first 1 week of life clearly facilitates extubation and shortens the duration of intubation among ventilator-dependent, very preterm/extremely low birth weight infants, without any obvious short-term complications. Combined with recent evidence that infants at very high risk of bronchopulmonary dysplasia may benefit in the long term, our study reopens debate regarding the role of low-dose, late postnatal, corticosteroid therapy.