Clinical efficacy of budesonide combined with caffeine citrate for preventing bronchopulmonary dysplasia in preterm infants

doi:10.11852/zgetbjzz2018-0947

Abstract

Abstract: Objective To explore the clinical efficacy of early inhaled budesonide combined with caffeine citrate for preventing bronchopulmonary dysplasia(BPD) in very low birth weight(VLBW) infants,in order to provide evidence for the prevention and treatment of BPD. Methods A total of 60 VLBW infants with gestational age under 32 weeks and weight under 1 500 g in Binhu Hospital of Southern District,the First Hospital of Hefei City were enrolled in this study from October 2014 to October 2017,and were randomly assigned into budesonide combined with caffeine group(n=30) and caffeine group(n=30).Duration of ventilation,duration of oxygen supplementation,duration of hospitalization,mortality,incidence of BPD and common complications between the two groups were compared. Results Compared with the caffeine group,budesonide combined with caffeine group had a shorter duration of ventilation and oxygen supplementation(t=2.09,Z=-2.36,P <0.05).The incidence of BPD in budesonide combined with caffeine group was lower than that in caffeine group,but the difference was not statistically significant(P＞0.05).There were no significant differences on the duration of hospitalization and the incidence of other common complications between the two groups(P>0.05). Conclusion Early inhaled budesonide combined with caffeine citrate can effectively shorten the duration of ventilation and oxygen supplementation,and can reduce the incidence of BPD to some extent.

Key words: budesonide, caffeine citrate, bronchopulmonary dysplasia, very low birth weight infants

摘要： 目的分析早期联合使用吸入性布地奈德和枸橼酸咖啡因预防极低出生体重早产儿支气管肺发育不良(BPD)的临床疗效,以期为BPD的防治提供参考。方法 2014年10月-2017年10月在合肥市第一人民医院南区滨湖医院选取胎龄<32 周且出生体重低于1 500 g的极低出生体重儿 60例,随机分成咖啡因+布地奈德组(n=30例)和咖啡因组(n=30)。比较两组呼吸机使用时间、撤机后吸氧时间、住院时间、病死率、BPD 发生率及常见并发症的发生率。结果咖啡因+布地奈德组呼吸机使用时间和吸氧时间明显短于咖啡因组(t=2.09,Z=2.36,P<0.05),咖啡因+布地奈德组的BPD发生率较咖啡因组有所降低,但差异无统计学意义(P>0.05),两组住院时间及常见并发症的发生率差异无统计学意义(P>0.05)。结论早期联合使用吸入性布地奈德和枸橼酸咖啡因能够有效缩短呼吸机使用及吸氧时间,在一定程度上降低了BPD的发生率。

关键词: 布地奈德, 枸橼酸咖啡因, 支气管肺发育不良, 极低出生体重儿

CLC Number:

R722.6

CHEN Meng-Meng, WEN Xiao-hong, HUANG Jin-hua, SUN Ya-wei. Clinical efficacy of budesonide combined with caffeine citrate for preventing bronchopulmonary dysplasia in preterm infants[J]. journal1, 2019, 27(10): 1124-1127.

陈萌萌, 温晓红, 黄金华, 孙亚伟. 布地奈德联合咖啡因预防早产儿支气管肺发育不良的疗效研究[J]. 中国儿童保健杂志, 2019, 27(10): 1124-1127.

References

[1] Vom Hove M,Prenzel F,Uhlig HH,et al.Pulmonary outcome in former preterm,very low birth weight children with bronchopulmonary dysplasia:a case-control follow-up at school age[J] .J Pediatr,2014,164:40-45.
[2] Patel RM,Leong T,Carlton DP,et al.Early caffeine therapy and clinical outcomes in extremely preterm infants[J] .J Perinatol,2013,33:134-140.
[3] Doyle LW,Ehrenkranz RA,Halliday HL.Early(<8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants[J] .Cochrane Database Syst Rev,2014,5:CD001146.
[4] Jobe AH,Bancalari E.Bronchopulmonary dysplasia[J] .Am J Respir Crit Care Med,2001,163(7):1723-1729.
[5] Dionne JM,Abitbol CL,Flynn JT.Hypertension in infancy:diagnosis,management and outcome[J] .Pediatr Nephrol,2012,27(1):17-32.
[6] Sinclair JC,Bottino M,Cowett RM.Interventions for prevention of neonatal hyperglycemia in very low birth weight infants[J] .Cochrane Database Syst Rev,2011,5(10):7615-7617.
[7] Skinner J.Diagnosis of patentductus arteriosus[J] .Semin Neonatol,2001,6(1):49-61.
[8] Müller MJ,Paul T,Seeliger S.Necrotizing enterocolitis in premature infants and newborns[J] .J Neonatal Perinatal Med,2016,9(3):233-242.
[9] 中华医学会儿科学分会新生儿学组,中华医学会中华儿科杂志编辑委员会.新生儿肺出血的诊断与治疗方案[J] .中华儿科杂志,2001,39(4):248.
[10] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M] .北京:人民卫生出版社,2011:395-398.
[11] Northway WHJR,Rosan RC,Porter DY.Pulmonary disease following respirator therapy of hyaline-membrane disease.Bronchopulmonary dysplasia[J] .N Engl J Med,1967,276(7):357-368.
[12] Baraldi E,Filippone M.Chronic lung disease after premature birth[J] .N Engl J Med,2007,357(19):1946-1955.
[13] Jobe AH.What is BPD in 2012 and what will BPD become[J] .Early Hum Dev,2012,88(Suppl 2):27-28.
[14] Doyle LW,Halliday HL,Ehrenkranz RA,et al.An update on the impact of postnatal systemic corticosteroids on mortality and cerebral palsy in preterm infants:effect modification by risk of bronchopulmonary dysplasia[J] .J Pediatr,2014,165(6):1258-1260.
[15] Watterberg K.Evidence-based neonatal pharmacotherapy:postnatal corticosteroids[J] .Clin Perinatol,2012,39(1):47-59.
[16] Doyle LW,Ehrenkranz RA,Halliday HL.Postnatal hydrocortisone for preventing or treating bronchopulmonary dysplasia in preterm infants:a systematic review[J] .Neonatology,2010,98(2):111-117.
[17] Lim G,Lee BS,Choi YS,et al.Delayed dexamethasone therapy and neurodevelopmental outcomes in preterm infants with bronchopulmonary dysplasia[J] .Pediatrics and Neonatology,2015,56(4):261-267.
[18] Ohlsson A,Calvert SA,Hosking M,et al.Randomized controlled trial of dexamethasone treatment in very low birth weight infants with ventilator dependent chronic lung disease[J] .Acta Paediatrica,1992,81(10):751-756.
[19] Gupt S,Prasanth K,Chen CM,et al.Postnatal corticosteroids for prevention and treatment of chronic lung disease in the preterm newborn[J] .Int J Pediatr,2012,2012:315642.
[20] Bassler D,Plavka R,Shinwell ES,et al.Early Inhaled Bud esonide for the Prevention of Bronchopulmonary Dysplasia[J] .New England Journal of Medicine,2015,373(16):1497-1506.
[21] Shah VS,Ohlsson A,Halliday HL,et al.Early administration of inhaled corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates[J] .Cochrane Database Syst Rew,2012,5:CD001969.
[22] Onland W,Offringa M,van Kaam A.Late(≥ 7 days) inhalation corticosteroids to reduce bronchopulmonary dysplasia in preterm infants[J] .Cochrane Database Syst Rew,2012,4:CD002311.
[23] 潘静,陈名武,倪文泉,等.肺表面活性物质联合布地奈德预防极低出生体重儿支气管肺发育不良的疗效观[J] .中国当代儿科杂志,2017,19(2):137-141.
[24] Dugas MA.Fluticasone inhalation in moderate cases of bron chopulmonary dysplasia[J] .Pediatrics,2005,115(5):566-572.
[25] Yeh TF,Chen CM,Wu SY,et al.Intratracheal administration of budesonide/surfactant to prevent bronchopulmonary dysplasia[J] .Am J Respir Crit Care Med,2016,193(1):86-95.