Adverse effects of early dexamethasone treatment in extremely-low-birth-weight infants
Adverse effects of early dexamethasone treatment in extremely-low-birth-weight infants
复制标题
DOI：
10.1056/nejm200101113440203
复制
发表时间：
2001-01-11
影响因子：
158.5
通讯作者：
Stoll, BJ
中科院分区：
文献类型：
--
作者：
Stark, AR;Carlo, WA;Stoll, BJ
背景：早期使用大剂量地塞米松可能会降低早产儿患慢性肺部疾病的风险，但可能会导致并发症。目前尚不清楚中等剂量是否同样有效但更安全。方法：我们随机将220名出生体重在501-1000g之间的婴儿随机分为地塞米松组和安慰剂组，这些婴儿出生后12小时内接受机械通气治疗，同时接受常规机械通气支持或允许性高碳酸血症。地塞米松在出生后24小时内以每天每公斤体重0.15毫克的剂量服用，连续三天，然后在七天内逐渐减少剂量。结果：接受地塞米松治疗的婴儿与接受安慰剂治疗的婴儿相比，死亡或慢性肺部疾病的相对风险为0.9(95%可信区间为0.8至1.1)。由于地塞米松的治疗效果并不因呼吸途径而异，因此将两个地塞米松组和两个安慰剂组合并使用。与安慰剂组相比，地塞米松组婴儿在出生后28天接受氧气补充(P=0.004.0 1)或开放标签地塞米松(P=0.0 1)的可能性较小，而患高血压的可能性较高(P
Background: Early administration of high doses of dexamethasone may reduce the risk of chronic lung disease in premature infants but can cause complications. Whether moderate doses would be as effective but safer is not known.Methods: We randomly assigned 220 infants with a birth weight of 501 to 1000 g who were treated with mechanical ventilation within 12 hours after birth to receive dexamethasone or placebo with either routine ventilatory support or permissive hypercapnia. The dexamethasone was administered within 24 hours after birth at a dose of 0.15 mg per kilogram of body weight per day for three days, followed by a tapering of the dose over a period of seven days. The primary outcome was death or chronic lung disease at 36 weeks' postmenstrual age.Results: The relative risk of death or chronic lung disease in the dexamethasone-treated infants, as compared with those who received placebo, was 0.9 (95 percent confidence interval, 0.8 to 1.1). Since the effect of dexamethasone treatment did not vary according to the ventilatory approach, the two dexamethasone groups and the two placebo groups were combined. The infants in the dexamethasone group were less likely than those in the placebo group to be receiving oxygen supplementation 28 days after birth (P=0.004) or open-label dexamethasone (P=0.01), were more likely to have hypertension (P