Prophylactic postnatal corticosteroids: Early hydrocortisone |
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| Affiliation: | 1. Division of Neonatology and Pediatric Intensive Care, University Hospitals Geneva, Geneva, Switzerland;2. Division of Neonatology, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM, USA;1. , Newborn Research Centre, The Royal Women’s Hospital;2. University of Auckland, Liggins Institute;1. Division of Neonatology, Department of Pediatrics, University of California, Davis, California, USA;2. Department of Pediatrics, Adventist Health Rideout Hospital, Marysville, CA, USA;1. Neonatal Intensive Care Centre, King''s College Hospital NHS Foundation Trust, London, UK;2. Women and Children''s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King''s College London, London, UK;3. The Asthma UK Centre in Allergic Mechanisms of Asthma, King''s College London, London, UK;4. National Institute for Health Research Biomedical Research Centre based at Guy''s and St Thomas'' NHS Foundation Trust and King''s College London, London, UK;1. Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia;2. Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan;3. School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, Australia;4. Division of Pulmonary Biology, Cincinnati Children''s Hospital Medical Center, 3333 Burnet Avenue | MLC 7029, Cincinnati, OH, 45229, USA |
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| Abstract: | ![]()
Inflammation is a key contributor to the pathogenesis of bronchopulmonary dysplasia (BPD) in preterm infants, and cortisol plays a central role in controlling inflammation. Insufficient cortisol limits the ability of the sick newborn to handle stress and inhibit pulmonary inflammation. Evidence of lower cortisol and lower response to adrenocorticotropic hormone in infants subsequently developing BPD led to studies of early low-dose hydrocortisone to prevent BPD. Based on four randomised clinical trials enrolling almost 1000 extremely preterm infants, prophylaxis of early adrenal insufficiency with low-dose hydrocortisone significantly decreased BPD and mortality, as well as medical treatment for a patent ductus arteriosus. An increase in late-onset sepsis reported in the most immature infants had no adverse effect on mortality or neurodevelopmental outcomes. There was no increase in gastrointestinal perforation in the absence of indomethacin. The demonstrated beneficial effects of early low-dose hydrocortisone make a strong case for its use in extremely preterm infants at high risk for BPD. |
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| Keywords: | Hydrocortisone Bronchopulmonary dysplasia Prematurity Inflammation |
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