| Objective: In order to explore the effectiveness and safety of intravenous glucocorticoids in the treatment of early bronchopulmonary dysplasia(BPD),and to provide a clinical evidence for the prevention and treatment of BPD.Methods: A retrospective analysis was performed among the newborns with a gestational age of ?30 weeks and a birth weight of ?1500g,which admitted in the neonatal intensive care unit of our hospital from January 2016 to July 2019.At the same time,according to the inclusion and exclusion criteria,the very premature infants with early BPD,defined as need respiratory support or oxygenation at 28 th day after birth.According to the use of glucocorticoid,BPD infants were divided into dexamethasone(DXM)group(n=24),hydrocortisone(HC)group(n=37)and the control group(n=50).The infants in control group were received routine treatments according to the clinical conditions,such as caffeine to prevent apnea,limited fluid volume,respiratory support,nutritional support,and antibiotics for onset of infection.Except for the above basic treatment,the infants in DXM group was given dexamethasone by intravenous,0.15 mg/(kg.d)× 5 days and reduced to 0.05 mg/(kg.d)× 2 days,0.02 mg/(kg.d)× 2 days,divided into 2 times a day,with the total course of 9 days and the average dose of 0.89 mg/kg.For the infants in the HC group,HC was given 1 mg/(kg.d)× 7 days,and reduced to 0.5 mg/(kg.d)× 3 days,divided into 2 times a day,with the total course of 10 days and the average dose of 8.5 mg/kg.The drug was used within 24 hours while early BPD was diagnosed.At the same time,the basic demographic characteristics,basic treatment measures,complications during hospitalization,and the short-term outcomes in each group were collected.The SPSS 17.0 software was used to compare and analyze the perinatal background factors,treatment process,complications during hospitalization,and clinical outcomes among three groups.The side effects of the drug were also recorded and compared among three groups.Results: A total of 111 eligible infants with early BPD were included,including 59 males and 52 females: 50 in the control group,37 in the HC group,and 24 in the DXM group.Compared with the control group,infants had lower birth weight in DXM group(1225±142g vs 1120±177g,P=0.009)and HC group(1225±142g vs 1134±167g,P=0.01),and had shorter gestation days(the control group,203 d vs the DXM group,200 d,P = 0.021 and the control group,203 d vs the HC group,199 d,P=0.007,respectively)at birth,while there were no significant differences in other basic demographic characteristics(P all > 0.05);During in hospitalization,there were no significant differences in the basic treatment measures and complications among infants in the three groups(P all >0.05);At 36 th week of postmenstrual age,there was no significant difference in the incidence of moderate and severe BPD between three groups;The average time of oxygen supplement in the DXM group was shorter than that in the control group(37d vs 49 d,P=0.002)and in the HC group(37d vs 50 d,P=0.004).Furthermore,the infants in the DXM group were deoxygenated faster than those in the HC group(8d vs 21 d,P=0.003)from the beginning of the glucocorticoid use.At the same time,no increased incidences of common clinical complications,such as retinopathy of prematurity,periventricular leukomalacia,intraventricular hemorrhage,infection and other drug-related complications,were observed among infants in DXM group or in HC group,compared with the infants in control group(P all >0.05).Conclusion: Using dexamethasone or hydrocortisone to treat early BPD can not reduce the incidence of moderate to severe BPD at 36 th week of postmenstrual age.However,dexamethasone can shorten the duration of oxygen supplement in infants with early BPD,and has no short-term adverse side effects.However,as a retrospective study,selection bias was not avoided.A multi-center,large-scale randomized controlled trial needs to be performed to verify the effectiveness and safety of DXM for early BPD treatment. |
PDF Full Text Request