预治疗患儿血中氢化可的松浓度可预测支气管肺发育不良高危婴儿对预防性应用皮质醇的反应

来源 :世界核心医学期刊文摘(儿科学分册) | 被引量 : 0次 | 上传用户:zi198
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Objectives: To investigate the effect of hydrocortisone treatment on survival without bronchopulmonary dysplasia (BPD) and to study whether serum cortisol con centrations predict the response. Study design: We performed a randomized, place bo-controlled trial on infants with gestation ≤30 weeks, body weight of 501 to 1250 g, and respiratory failure. Hydrocortisone was started before 36 hours of age and given for 10 days at doses from 2.0 to 0.75 mg/kg per day. Shortly befor e hydrocortisone treatment, basal and stimulated (ACTH, 0.1 μg/kg) serum cortis ols were measured. Results: The study was discontinued early, because of gastroi ntestinal perforations in the hydrocortisone group (4/25 vs 0/26, P =. 05); 3 of the 4 had received indomethacin/ibuprofen. The incidence of BPD (28%vs placebo 42%, P = 0.28) tended to be lower, and patent ductus arteriosus (36%vs 73%, P =. 01)was lower in the hydrocortisone group. The hydrocortisone-treated infan ts with serum cortisol concentrations above the median had a high risk of gastro intestinal perforation. In infants with cortisol values below the median, hydroc ortisone treatment increased survival without BPD. Conclusions: Serum cortisol c oncentrations measured shortly after birth may identify those very high-risk in fants who may benefit from hydrocortisone supplementation. Objectives: To investigate the effect of hydrocortisone treatment on survival without bronchopulmonary dysplasia (BPD) and to study whether serum cortisol con centrations predict the response. Study design: We performed a randomized, place bo-controlled trial on infants with gestation ≤ 30 weeks, Hydrocortisone was started before 36 hours of age and given for 10 days at doses from 2.0 to 0.75 mg / kg per day. Shortly befor e hydrocortisone treatment, basal and stimulated (ACTH, 0.1 Results: The study was discontinued early, because of gastroi ntestinal perforations in the hydrocortisone group (4/25 vs 0/26, P =. 05); 3 of the 4 had received indomethacin / ibuprofen. The incidence of BPD (28% vs. placebo 42%, P = 0.28) tended to be lower, and patent ductus arteriosus (36% vs 73%, P = .01) was lower in the hydrocortisone group. infan ts with serum cortisol concentrations abo ve the median had a high risk of gastrointestinal perforation. In infants with cortisol values ​​below the median, hydrocortisone treatment increased survival without BPD. Conclusions: Serum cortisol c oncentrations measured shortly after birth may identify those very high-risk in fants who may benefit from hydrocortisone supplementation.
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