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Systemic postnatal corticosteroid use for the prevention of bronchopulmonary dysplasia and its relationship to early neurodevelopment in extremely preterm

查看全文 作　　者：Emilia [1]Esterman;Traci-Anne [1]Goyen;Pranav [1,2]Jani;Gemma [1]Lowe;Jane [1]Baird;Rajesh [1,2]Maheshwari;Daphne D’[1]Cruz;Melissa [1]Luig;Dharmesh [1,2]Shah 高影响力作者 机构地区：[1]Department of Neonatology,Westmead Hospital,Westmead,Australia;[2]Faculty of Medicine and Health,The University of Sydney,Sydney,Australia高影响力机构 出　　处：《World Journal of Pediatrics》索引2023年第19卷第6期,共9页高影响力期刊 基　　金：Open Access funding enabled and organized by CAUL and its Member Institutions. 摘　　要：Background Systemic postnatal corticosteroid use in extremely preterm infants poses a risk of adverse neurodevelopmental outcomes.This study explores their use beyond seven days of age with early neurodevelopmental assessments during the fidgety period(9-20 weeks postterm age).Methods This retrospective single-center cohort study included inborn extremely preterm infants from 1 January 2014 to 31 December 2018.Outborn infants,those with congenital or genetic abnormalities,and those who received postnatal cor-ticosteroids for nonrespiratory reasons were excluded.The cohort was dichotomized based on the status of corticosteroid receipt.Early neurodevelopmental outcomes were reported using Prechtl's General Movements Assessment.Results Of the 282 infants,67(23.75%)received corticosteroids.Of these,34(50.75%)received them for dependency on invasive ventilation(intermittent positive-pressure ventilation),and the remainder received them for dependency on non-invasive ventilation continuous positive airway pressure(CPAP)or bi-level positive airway pressure(BiPAP).Abnormal or absent fidgety movements were observed in 13% of infants(7/54)who received corticosteroids compared to 2% of infants(3/146)who did not.An increased odds for an abnormal general movements assessment from corticosteroid use after adjusting for gestational age[adjusted odds ratio(aOR)=5.5,95% confidence interval(CI)=1.14-26.56]was observed.The motor optimality scores differed between the two groups[corticosteroid group:25.5(23-26)versus no-corticosteroid group:26(24-28);z=-2.02].A motor optimality score<20 was observed in 14.8% of infants(8/54)in the corticosteroid group compared to 2% of infants(3/146)in the noncorticosteroid group.This difference was significant after adjustment for gestational age(aOR 5.96,95%CI 1.28-27.74).Conclusions Abnormal early neurodevelopment was observed in infants who received systemic postnatal corticosteroids.The relationship between these findings and other factors influencing early neurodevelopment needs further exploration. 关 键 词：CORTICOSTEROIDS Early neurodevelopment General movement assessment Preterm infants
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