LUNG FUNCTION POST STEROIDS IN CHRONIC VENTILATED INFANT

本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况的影响 出生时体重低于1，500克，需依赖呼吸机并需吸氧 3周龄时补充。 这些婴儿是最高风险的 支气管肺发育不良（BPD），慢性肺 呼吸机和辅助供氧治疗并发症 治疗呼吸衰竭。 婴儿的长期结局 研究将在1岁、2岁和3岁时进行检查， 持续性慢性肺病、肺心病、神经发育和 增长问题。 虽然这些婴儿的类固醇治疗一直是 据报道，目前还没有前瞻性的随机对照试验， 大群婴儿，以确定这种治疗干预是否应该 用于正在发育或患有BPD的婴儿。 目前，BPD 主要是出生体重低于1，500克的婴儿的并发症 患有呼吸衰竭，需要机械通气， 2周或更长时间的补充氧气治疗。 仍然有 BPD患者的死亡率为25%，发病率显著。 这 这项研究可能包括60至90名婴儿， 给予地塞米松或安慰剂的双盲研究 静脉注射10天。 肺功能测量 会在治疗试验前后进行 这些研究将 包括每分钟通气量、顺应性、肺 阻力、呼吸功、肺泡动脉氧和二氧化碳 压差、生理死腔和功能残气量。 肺功能研究的初步报告表明， 顺应性提高，呼吸功减少， 可以脱离机械通气， 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，3岁时可脱离机械通气。 周的年龄，持续的肺损伤和BPD的发展， 可显著降低长期肺部发病率。 本研究 重要的是，这些数据将决定类固醇是否有效， 改善肺功能，从而减少通气时间 没有严重的不良影响。 如果类固醇证明无效， 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.