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Barksterameðferð við erfiðum lungnasjúkdómi hjá fyrirburum

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Authors
Erna Hinriksdóttir
Hrólfur Brynjarsson
Þórður Þorkelsson
Issue Date
2016-05-04

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Other Titles
Postnatal corticosteroids in preterm infants with immature lung disease
Citation
Læknablaðið 2016, 2016 (05):219
Abstract
Tilgangur: Margir fyrirburar með erfiðan lungnasjúkdóm eru meðhöndlaðir með barksterum í æð eða á úðaformi í þeim tilgangi að ná þeim af öndunarvél og/eða minnka súrefnisþörf þeirra. Umdeilt er hvort ávinningurinn af meðferðinni sé nægur til að vega upp á móti hugsanlegum aukaverkunum, einkum sterameðferðar í æð. Megintilgangur rannsóknarinnar var að kanna áhrif barksterameðferðar í æð eða á úðaformi á þörf fyrirbura fyrir öndunarvélameðferð og súrefnisgjöf og kanna hugsanlegar aukaverkanir meðferðarinnar. Efniviður og aðferðir: Rannsóknin var afturskyggn hóprannsókn á fyrirburum á vökudeild Barnaspítala Hringsins, fæddum 2000-2014, sem fengu barksterameðferð í æð (n=28) eða á úðaformi (n=30) við erfiðum lungnasjúkdómi. Eitt viðmið var valið fyrir hvert tilfelli, parað á meðgöngulengd. Niðurstöður: Marktæk lækkun varð á súrefnisþörf barna sem fengu barkstera í æð eða á úðaformi fyrstu dagana eftir að meðferð hófst en ekki hjá viðmiðum. Marktækt fleiri tilfelli en viðmið þurftu öndunarvélameðferð við upphaf steragjafar í æð, en ekki fjórum dögum síðar. Marktækt minni þyngdaraukning varð hjá tilfellum sem fengu stera í æð en viðmiðum á meðferðartímabilinu, en við 35 vikna meðgöngualdur var ekki marktækur þyngdarmunur milli hópanna tveggja. Ekki reyndist marktækur munur á öðrum hugsanlegum aukaverkunum milli hópanna, svo sem tíðni heilalömunar. Ályktanir: Barksterameðferð í æð eða á úðaformi minnkar súrefnisþörf fyrirbura og barksteragjöf í æð flýtir því að börnin náist af öndunarvél, án verulegra aukaverkana. Því kemur til greina að nota barkstera hjá fyrirburum með erfiðan lungnasjúkdóm í völdum tilvikum.
Introduction: Corticosteroids have been used in preterm infants with immature lungs to decrease their need for supplemental oxygen and mechanical ventilation. Whether the benefits of the treatment outweigh possible adverse effects remains controversial. The main objective of the study was to evaluate the effects of intravenous and inhalation corticosteroids on preterm infants’ need for supplemental oxygen and mechanical ventilation and potential adverse effects. Material and methods: This was a retrospective cohort study on preterm infants at the Neonatal Intensive Care Unit of Children’s Hospital Iceland, born between 2000-2014 and treated with intravenous (n=28) or inhalation (n=30) corticosteroids for immature lung disease. For each infant receiving steriods one infant who did not receive steriods was selected as control, matched on gestational age. Results: There was a significant decrease in the need for supplemental oxygen following intravenous and inhalation corticosteroids administration, and a significant decrease in the need for mechanical ventilation following intravenous corticosteroids administration, but not in controls. Infants receiving intravenous corticosteroids gained significantly less weight than controls during treatment, but no significant difference in weight between groups was found at 35 weeks postmenstrual age, or in other possible adverse effects such as the prevalence of cerebral palsy. Conclusion: Intravenous and inhalation corticosteroids decrease the need for supplemental oxygen in preterm infants with immature lung disease and intravenous steriods facilitate earlier weaning from mechanical ventilation, without significant adverse effects. Therefore, it seems justifiable in selected cases to use corticosteroids in treatment of preterm infants with severe immature lung disease.
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To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.
Additional Links
http://www.laeknabladid.is/tolublod/2016/05/nr/5871
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Archived with thanks to Læknablaðið
ae974a485f413a2113503eed53cd6c53
10.17992/lbl.2016.05.79
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Icelandic Journal Articles (Peer Reviewed)

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