LUNG FUNCTION POST STEROIDS IN CHRONIC VENTILATED INFANT

这项建议的目的是评估静脉注射的效果。 地塞米松治疗对婴幼儿肺功能及临床状态的影响 出生体重小于1500克，依赖呼吸机并需要氧气 在3周龄时补充。这些婴儿患癌症的风险最高 慢性肺--支气管肺发育不良的发展 慢性阻塞性肺疾病并发机械通气和补充氧疗 呼吸衰竭的治疗。围产期婴儿的长期结局 研究将在1岁、2岁和3岁时进行检查，以寻找证据 持续的慢性肺病、肺心病、神经发育和 增长问题。尽管这些婴儿的类固醇治疗一直是 据报道，目前尚无前瞻性、随机对照试验 以确定这一治疗干预措施是否应该 适用于发育中或患有BPD的婴儿。目前，BPD为 主要是出生体重低于1,500克的婴儿的并发症 他们有呼吸衰竭，需要机械通风和 补充氧疗2周或更长时间。继续有一种 BPD患者中25%的死亡率和显著的发病率。这 这项研究可能包括60到90名婴儿，随机对照， 地塞米松或安慰剂的双盲研究 静脉注射，为期10天。肺功能测量 将在治疗试验之前和之后进行。这些研究将 包括每分钟通气量、顺应性、肺活量 阻力、呼吸功、肺泡-动脉血氧分压和二氧化碳 梯度、生理死腔和功能残存容量。 肺功能研究的初步报告表明，肺功能 顺应性提高，呼吸功减少，因此婴儿 可以脱离机械通气，从而中断肺 继发于气压伤和高氧补充的损伤。如果婴儿 出生时体重不超过1,500克的婴儿可以在3岁前脱离机械通风。 几周龄时，持续的肺损伤和BPD的发展 长期的肺部发病率可以显著降低。这项研究是 重要的是，这些数据将决定类固醇是否有效 改善肺功能，缩短呼吸机持续时间 没有严重的不良反应。如果类固醇被证明是无效的，这 也将是有价值的信息，因为不必要的类固醇治疗可能 避免了。

The purpose of this proposal is to evaluate the effects of intravenous dexamethasone therapy on pulmonary function and clinical status of infants less than 1,500 gm birthweight who are ventilator dependent and need oxygen supplementation at 3 weeks of age. These infants are at highest risk for the development of bronchopulmonary dysplasia (BPD), the chronic lung disease complicating ventilation and supplemental oxygen therapy in the treatment of respiratory failure. The long-term outcome to infants in the study will be examined at 1, 2, and 3 years of age for evidence of continuing chronic lung disease, cor pulmonale, neurodevelopmental and growth problems. Although steroid therapy of these infants has been reported, there has been no prospective, randomly controlled trial in a large group of infants to determine if this therapeutic intervention should be used in infants who are developing or who have BPD. Currently, BPD is predominantly a complication for infants less than 1,500 gm birth weight who have had respiratory failure and have needed mechanical ventilation and supplemental oxygen therapy for 2 weeks or longer. There continues to be a 25% mortality and significant morbidity in patients who have BPD. This study would potentially include 60 to 90 infants in a randomly controlled, double blind study where either dexamethasone or placebo would be given intravenously for a period of 10 days. Pulmonary function measurements would be made before and after the therapeutic trial. These studies would include measurements of minute ventilation, compliance, pulmonary resistance, work of breathing, alveolar-arterial oxygen and carbon dioxide gradients, physiologic dead space and functional residual capacity. Preliminary reports of pulmonary function studies suggest that pulmonary compliance improves and the work of breathing decreases so that the infant can be weaned from mechanical ventilation and thereby interrupt the lung injury secondary to barotrauma and high oxygen supplementation. If infants 1,500 gm or less at birth can be weaned from mechanical ventilation by 3 weeks of age, the ongoing lung injury and development of BPD with its long-term pulmonary morbidity can be significantly reduced. This study is important because these data will determine if steroids are effective in improving lung function so that the duration of ventilation can be reduced without serious adverse effects. If the steroids prove ineffective, this also would be valuable information since unnecessary steroid therapy can be avoided.