Timing of postnatal corticosteroid treatment for bronchopulmonary dysplasia and its effect on outcomes
Timing of postnatal corticosteroid treatment for bronchopulmonary dysplasia and its effect on outcomes
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DOI：
10.1002/ppul.24202
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发表时间：
2019-02-01
影响因子：
3.1
通讯作者：
Truog, William E.
中科院分区：
文献类型：
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作者：
Cuna, Alain;Lewis, Tamorah;Truog, William E.
目的探讨类固醇治疗支气管肺发育不良（BPD）的时机与预后的关系。方法对低剂量地塞米松治疗BPD的早产儿进行回顾性队列研究。在出生日（DOL） 14-28（中晚期组）与在出生日（DOL） 29-42（延迟组）接受类固醇治疗的婴儿进行比较。使用治疗加权逆概率（IPTW）调整倾向评分来纠正潜在的混杂因素。主要观察指标为出院时月经后年龄（PMA）。结果患儿55例（中度晚期治疗25例，迟发性治疗30例）。中度迟发组平均治疗年龄为23天，迟发组平均治疗年龄为35天。在治疗时，与较晚治疗的婴儿相比，中度晚治疗的婴儿更有可能接受高频通气（96%对47%，P < 0.0001），吸入氧的比例更高（70.7 +/- 17.9%对56.2 +/- 18.4%,P = 0.005）。尽管是病情较重的一组，与延迟治疗的婴儿相比，中度晚治疗的婴儿在更早的矫正年龄出院（PMA 42.9 +/- 4.5 vs 47.5 +/- 8.3周，IPTW调整P = 0.03）。中度晚期治疗还与较少的机械通气天数（46.0 +/- 19.0天vs 77.4 +/- 67.0天，经IPTW调整P = 0.02）和较少的补充氧天数（114.3 +/- 40.8天vs 149.8 +/- 57.0天，经IPTW调整P = 0.005）相关。结论：在BPD高风险的早产儿中，与早期治疗相比，延迟使用产后类固醇治疗与相对较差的短期预后相关。
Objective To determine the association of timing of steroid therapy for bronchopulmonary dysplasia (BPD) and outcomes. Methods Retrospective cohort study of preterm infants treated with low-dose dexamethasone for BPD. Infants treated with steroids at day of life (DOL) 14-28 (moderately late group) were compared to infants treated at DOL 29-42 (delayed group). Inverse probability of treatment weighting (IPTW) adjusted propensity scores were used to correct for potential confounders. The primary outcome of interest was postmenstrual age (PMA) at discharge. Results Fifty-five infants (25 with moderately late treatment; 30 with delayed treatment) were identified. The mean age at treatment was 23 days in the moderately late group and 35 days in the delayed group. At time of treatment, infants treated moderately late were more likely to be on high frequency ventilation (96% vs 47%, P < 0.0001) and had higher fraction of inspired oxygen (70.7 +/- 17.9% vs 56.2 +/- 18.4%, P = 0.005) compared to infants treated later. Despite being the sicker group, moderately late treated infants were discharged at an earlier corrected age compared to infants with delayed treatment (PMA 42.9 +/- 4.5 vs 47.5 +/- 8.3 weeks, IPTW adjusted P = 0.03). Moderately late treatment was also associated with fewer days on mechanical ventilation (46.0 +/- 19.0 days vs 77.4 +/- 67.0 days, IPTW adjusted P = 0.02) and fewer days on supplemental oxygen (114.3 +/- 40.8 days vs 149.8 +/- 57.0 days, IPTW adjusted P = 0.005). Conclusions Among preterm infants at high risk of BPD, delaying treatment with postnatal steroids is associated with comparatively worse short-term outcomes as compared to earlier treatment.