Short-term pulmonary and systemic effects of hydrocortisone initiated 7-14 days after birth in ventilated very preterm infants: a secondary analysis of a randomised controlled trial.
| Autor: | Halbmeijer NM; Neonatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.; Research Institute, Amsterdam Reproduction and Development, Amsterdam, The Netherlands., Onland W; Neonatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.; Research Institute, Amsterdam Reproduction and Development, Amsterdam, The Netherlands., Cools F; Neonatology, Universitair Ziekenhuis Brussel, Brussels, Belgium., Kroon A; Neonatology, Erasmus Medical Center, Rotterdam, The Netherlands., van der Heide-Jalving M; Neonatology, Isala Medical Center, Zwolle, The Netherlands., Dijk P; Neonatology, University Medical Centre Groningen, Beatrix Children's Hospital, Groningen, The Netherlands., van Straaten HLM; Neonatology, Isala Medical Center, Zwolle, The Netherlands., Te Pas AB; Neonatology, Leiden University Medical Center, Leiden, The Netherlands., Mohns T; Neonatology, Maxima Medical Centre Location Veldhoven, Veldhoven, The Netherlands., Bruneel E; Neonatology, Ziekenhuis Oost-Limburg, Genk, Belgium., van Heijst AFJ; Neonatology, Radboud University Medical Center-Amalia Children's Hospital, Nijmegen, The Netherlands., Kramer B; Neonatology, Maastricht University Medical Center+, Maastricht, The Netherlands., Debeer A; Neonatology, Universitair Ziekenhuis Leuven, Leuven, Belgium., Zonnenberg IA; Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands., Marechal Y; Neonatology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium., Blom H; Neonatology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium., Plaskie K; Neonatology, St Augustinus Ziekenhuis, Antwerp, Belgium., Merkus MP; Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands., Offringa M; Neonatology and Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada., van Kaam AH; Neonatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands a.h.vankaam@amsterdamumc.nl.; Research Institute, Amsterdam Reproduction and Development, Amsterdam, The Netherlands. |
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| Jazyk: | angličtina |
| Zdroj: | Archives of disease in childhood. Fetal and neonatal edition [Arch Dis Child Fetal Neonatal Ed] 2023 Jan; Vol. 108 (1), pp. 20-25. Date of Electronic Publication: 2022 May 09. |
| DOI: | 10.1136/archdischild-2022-323882 |
| Abstrakt: | Objective: Observational studies in preterm infants suggest that systemic hydrocortisone improves pulmonary condition but may also lead to systemic adverse effects. We report the short-term pulmonary and systemic effects of hydrocortisone initiated in the second week. Design: Randomised placebo-controlled trial. Setting: Dutch and Belgian neonatal intensive care units. Patients: Infants born <30 weeks' gestation and/or birth weight <1250 g, and ventilator dependent in the second week of life. Intervention: Infants were randomly assigned to a 22-day course of systemic hydrocortisone (cumulative dose 72.5 mg/kg; n=182) or placebo (n=190). Main Outcome Measures: Data on extubation, ventilator settings, glucose levels, and blood pressure were recorded daily and analysed during the first 7 days of treatment using linear mixed-effects models. Results: Infants in the hydrocortisone group (24.3%) failed extubation less often compared with placebo (38.6%, crude risk difference: -14.3% (95% CI: -23.4% to -4.8%)). The estimated difference in daily rate of change between hydrocortisone and placebo was -0.42 cmH Conclusions: Systemic hydrocortisone initiated between 7 and 14 days after birth in ventilated preterm infants improves pulmonary condition, thereby facilitating weaning and extubation from invasive ventilation. The effects of hydrocortisone on blood glucose levels and blood pressure were mild and of limited clinical relevance. Trial Registration Number: Netherlands Trial Register (NTR2768; https://www.trialregister.nl/trial/2640) and European Union Clinical Trials Register (EudraCT, 2010-023777-19). Competing Interests: Competing interests: AHvK reports grants from The Netherlands Organization for Health Research and Development ZonMW during the conduct of the study. No other disclosures were reported. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.) |
| Databáze: | MEDLINE |
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