PDF(Pubmed)
Abstract：
UNASSIGNED: Prolonged mechanical ventilation, commonly used to assist preterm newborns, increases the risk of developing bronchopulmonary dysplasia (BPD). In recent decades, studies have demonstrated that systemic corticosteroids play a significant role in the prevention and management of BPD. In this systematic review of randomized controlled trials (RCTs), we evaluated the association between the administration of systemic corticosteroids in preterm infants and its long-term outcomes, such as neurodevelopment, growth, extubation rate, and related adverse effects.
UNASSIGNED: We conducted an electronic search in Medline, Scopus, and PubMed using the following terms: \"premature infants\" and \"corticosteroids.\" We considered all RCTs published up to June 2023 as eligible. We included all studies involving preterm newborns treated with systemic corticosteroids and excluded studies on inhaled corticosteroids.
UNASSIGNED: A total of 39 RCTs were evaluated. The influence of steroids administered systemically during the neonatal period on long-term neurological outcomes remains unknown, with no influence observed for long-term growth. The postnatal administration of systemic corticosteroids has been found to reduce the timing of extubation and improve respiratory outcomes. Dexamethasone appears to be more effective than hydrocortisone, despite causing a higher rate of systemic hypertension and hyperglycemia. However, in the majority of RCTs analyzed, there were no differences in the adverse effects related to postnatal corticosteroid administration.
UNASSIGNED: Dexamethasone administered during the neonatal period appears to be more effective than hydrocortisone in terms of respiratory outcomes; however, caution should be taken when administering dexamethasone. Data derived from current evidence, including meta-analyses, are inconclusive on the long-term effects of the administration of systemic steroids in preterm infants or the possibility of neurodevelopmental consequences.
UNASSIGNED: We conducted an electronic search in Medline, Scopus, and PubMed using the following terms: \"premature infants\" and \"corticosteroids.\" We considered all RCTs published up to June 2023 as eligible. We included all studies involving preterm newborns treated with systemic corticosteroids and excluded studies on inhaled corticosteroids.
UNASSIGNED: A total of 39 RCTs were evaluated. The influence of steroids administered systemically during the neonatal period on long-term neurological outcomes remains unknown, with no influence observed for long-term growth. The postnatal administration of systemic corticosteroids has been found to reduce the timing of extubation and improve respiratory outcomes. Dexamethasone appears to be more effective than hydrocortisone, despite causing a higher rate of systemic hypertension and hyperglycemia. However, in the majority of RCTs analyzed, there were no differences in the adverse effects related to postnatal corticosteroid administration.
UNASSIGNED: Dexamethasone administered during the neonatal period appears to be more effective than hydrocortisone in terms of respiratory outcomes; however, caution should be taken when administering dexamethasone. Data derived from current evidence, including meta-analyses, are inconclusive on the long-term effects of the administration of systemic steroids in preterm infants or the possibility of neurodevelopmental consequences.
摘要：
■长时间的机械通气，通常用于帮助早产新生儿，增加发生支气管肺发育不良（BPD）的风险。近几十年来,研究表明，全身性糖皮质激素在BPD的预防和治疗中起着重要作用。在这项对随机对照试验(RCTs)的系统评价中，我们评估了早产儿全身使用糖皮质激素与其长期结局之间的关系,比如神经发育，增长,拔管率,以及相关的不良影响。
■我们在Medline进行了电子搜索，Scopus,和PubMed使用以下术语：“早产儿”和“皮质类固醇”。“我们认为截至2023年6月发布的所有RCT都是合格的。我们纳入了所有涉及接受全身性皮质类固醇治疗的早产新生儿的研究，并排除了有关吸入皮质类固醇的研究。
■共评估了39项随机对照试验。在新生儿期全身使用类固醇对长期神经系统结局的影响仍然未知，对长期增长没有影响。已发现全身性皮质类固醇的产后给药可减少拔管的时机并改善呼吸结果。地塞米松似乎比氢化可的松更有效，尽管引起较高的全身性高血压和高血糖率。然而,在大多数分析的RCT中，与出生后使用皮质类固醇相关的不良反应没有差异.
■在新生儿期间给予地塞米松似乎比氢化可的松在呼吸结局方面更有效；然而，给予地塞米松时应谨慎。来自当前证据的数据，包括荟萃分析，对早产儿全身类固醇给药的长期影响或神经发育后果的可能性尚无定论。
■我们在Medline进行了电子搜索，Scopus,和PubMed使用以下术语：“早产儿”和“皮质类固醇”。“我们认为截至2023年6月发布的所有RCT都是合格的。我们纳入了所有涉及接受全身性皮质类固醇治疗的早产新生儿的研究，并排除了有关吸入皮质类固醇的研究。
■共评估了39项随机对照试验。在新生儿期全身使用类固醇对长期神经系统结局的影响仍然未知，对长期增长没有影响。已发现全身性皮质类固醇的产后给药可减少拔管的时机并改善呼吸结果。地塞米松似乎比氢化可的松更有效，尽管引起较高的全身性高血压和高血糖率。然而,在大多数分析的RCT中，与出生后使用皮质类固醇相关的不良反应没有差异.
■在新生儿期间给予地塞米松似乎比氢化可的松在呼吸结局方面更有效；然而，给予地塞米松时应谨慎。来自当前证据的数据，包括荟萃分析，对早产儿全身类固醇给药的长期影响或神经发育后果的可能性尚无定论。
