Outcomes in extremely preterm neonates after the introduction of early low-dose hydrocortisone treatment: A retrospective case-control study

IF 2.1 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development Pub Date : 2026-03-01 Epub Date: 2025-12-18 DOI:10.1016/j.earlhumdev.2025.106463

Ellie Purcell , Pooja Sachdev , Dushyant Batra

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引用次数: 0

Abstract

Objective

Assess the association between use of early low-dose hydrocortisone (ELDH) in extremely preterm neonates, and bronchopulmonary dysplasia (BPD)-free survival at 36 weeks completed gestational age (CGA), as well as additional secondary outcomes.

Design

Retrospective, matched, case-control study.

Setting

Tertiary neonatal intensive care units in Nottingham University Hospitals NHS Trust (Queens Medical Centre and Nottingham City Hospital).

Patients

188 extremely preterm neonates. 94 historical controls born between 1 October 2017 and 30 September 2019. 94 cases born between 1 January 2020 and 31 December 2021.

Interventions

ELDH using the published PREMILOC study protocol (total dose of 8.5 mg/kg over 10 days) initiated within the first 24 h of life.

Primary outcome measure

Survival without BPD at 36 weeks CGA.

Results

There were no statistically significant associations between the sex, gestational age or birthweight of the groups. There was no significant association between the use of ELDH and increased survival without BPD at 36 weeks CGA (p = 0.153) or reduction in mortality (p = 0.814). Using ELDH was significantly associated with an increased incidence of culture positive late-onset sepsis (p = 0.006), higher non-invasive respiratory support days (p = 0.032) and a longer total length of stay (p = 0.004).

Conclusions

ELDH use was not associated with an improvement in BPD free survival in extremely preterm neonates. The cases had a higher incidence of culture positive late-onset sepsis and longer duration of respiratory support. Further research exploring stratification of preterm neonates that will benefit from ELDH is needed.

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引入早期低剂量氢化可的松治疗后极早产儿的结局：一项回顾性病例对照研究。

目的：评估极早产新生儿早期使用低剂量氢化可的松（ELDH）与36周全胎龄（CGA）无支气管肺发育不良（BPD）生存率之间的关系，以及其他次要结局。设计：回顾性、配对、病例对照研究。环境：诺丁汉大学医院NHS信托（女王医疗中心和诺丁汉市医院）的三级新生儿重症监护室。患者：188例极早产儿。2017年10月1日至2019年9月30日期间出生的94个历史对照。2020年1月1日至2021年12月31日期间出生的94例。干预措施：使用已公布的PREMILOC研究方案（总剂量为8.5 mg/kg，超过10天）在生命的前24小时内开始ELDH。主要结局指标：36周无BPD生存期。结果：两组患者的性别、胎龄和出生体重无统计学意义。使用ELDH与36周CGA时无BPD的生存率增加（p = 0.153）或死亡率降低（p = 0.814）之间无显著相关性。使用ELDH与培养阳性晚发型脓毒症发生率增加（p = 0.006）、无创呼吸支持天数增加（p = 0.032）和总住院时间延长（p = 0.004）显著相关。结论：ELDH的使用与极早产儿无BPD生存的改善无关。培养阳性的晚发型脓毒症发生率较高，呼吸支持持续时间较长。需要进一步研究将受益于ELDH的早产儿分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Early human development 医学-妇产科学

CiteScore

4.40

自引率

4.00%

发文量

100

审稿时长

46 days

期刊介绍： Established as an authoritative, highly cited voice on early human development, Early Human Development provides a unique opportunity for researchers and clinicians to bridge the communication gap between disciplines. Creating a forum for the productive exchange of ideas concerning early human growth and development, the journal publishes original research and clinical papers with particular emphasis on the continuum between fetal life and the perinatal period; aspects of postnatal growth influenced by early events; and the safeguarding of the quality of human survival. The first comprehensive and interdisciplinary journal in this area of growing importance, Early Human Development offers pertinent contributions to the following subject areas: Fetology; perinatology; pediatrics; growth and development; obstetrics; reproduction and fertility; epidemiology; behavioural sciences; nutrition and metabolism; teratology; neurology; brain biology; developmental psychology and screening.