产后皮质类固醇和支气管肺功能障碍症:平衡肺部和神经效应,以实现个性化的决策
Nehal A Parikh1,2,3, Shipra Jain1,2,3
1The Perinatal Institute.
Current opinion in pediatrics
|January 27, 2026
概括
早期,中剂量德克萨米他在极早产的婴儿中,患有支气管肺功能障碍 (BPD) 的风险很高,可以减少BPD/死亡. 这种治疗也可以减少神经发育障碍,支持其使用,而不是晚期的低剂量策略.
科学领域:
- 新生儿医学 新生儿医学
- 儿科肺病学 儿科肺病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 支气管肺功能障碍 (BPD) 是神经发育障碍 (NDI) 和非常早产婴儿死亡的重要危险因素.
- 西方国家中BPD的发病率正在增加,需要有效的预防和治疗策略.
- 产后皮质类固醇 (PNC) 治疗,特别是甲,用于治疗BPD,但需要仔细评估风险和益处.
研究的目的:
- 审查BPD和PNC治疗在非常早产婴儿 (<32周怀孕) 的长期影响的证据.
- 以指导基于证据的BPD风险分层和个性化治疗决策.
- 优化PNC的时间和剂量,以管理BPD及其相关结果.
主要方法:
- 对德甲和其他PNCs的现有临床试验和数据进行系统审查和元回归分析.
- 评估与皮质类固醇治疗方案相关的BPD/死亡率和神经发育结果.
- 分析基线BPD风险如何改变德克萨米他治疗的影响.
主要成果:
- 在1周后开始服用中等剂量 (2-4毫克/公斤) 或高剂量 (4-8毫克/公斤) 的德克萨梅他可以减少BPD/死亡,并且可能不会对没有NDI的生存产生负面影响.
- 德克萨米他的有效性取决于风险:在BPD风险>50-70%的婴儿中有益,但在<30%的风险中可能有害.
- 适度早期 (8-14天) 中剂量德克萨米他提供了最大的BPD/死亡减少;高剂量疗程也有效,而低剂量或其他类固醇的效果较小.
结论:
- 中剂量全身德克萨米他,在8-14天之间开始,推给依赖呼吸器的婴儿,患BPD的风险高 (>50-70%).
- 这种疗法降低了BPD风险,也可能降低NDI风险,BPD降低的好处可能超过了直接的NDI毒性.
- 建议从晚期的低剂量德克萨米他过渡到中度早期的中剂量治疗,以降低非常早产婴儿的高BPD率.
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